MEDICARE: MS. JENNIFER GOODMAN LAND M.S.

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

General Provider Information

NPI Number	:	1639540891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER GOODMAN LAND M.S.

Provider Business Mailing Address
First Line	:	14750 BEACH BLVD
Second Line	:	#18
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2337
Country	:	US
Telephone Number	:	904-501-7402
Fax Number	:

Provider Business Practice Location Address
First Line	:	14750 BEACH BLVD
Second Line	:	#18
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2337
Country	:	US
Telephone Number	:	904-501-7402
Fax Number	:

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

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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