MEDICARE: MS. JENNIFER M. VAN ALLEN LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH9576	FL

General Provider Information

NPI Number	:	1528192028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER M. VAN ALLEN LMHC

Provider Business Mailing Address
First Line	:	4800 4TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-3817
Country	:	US
Telephone Number	:	727-422-7224
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 4TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-3817
Country	:	US
Telephone Number	:	727-422-7224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	05/13/2010

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