MEDICARE: JENELLA JENESE BROWN MCAP, RMHCI

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	IMH26964	FL
2	101YP2500X	Professional Counselor	MCAP.0101162	FL
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	MCAP.0101162	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MCAP.0101162	OTHER	FL	CERTIFIED MASTER'S LEVEL ADDICTION PROFESSIONAL
2	IMH26964	OTHER	FL	REGISTERED MENTAL HEALTH COUNSELOR INTERN

General Provider Information

NPI Number	:	1649977216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENELLA JENESE BROWN MCAP, RMHCI

Provider Business Mailing Address
First Line	:	PO BOX 572
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34673-0572
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 NW UNIVERSITY BLVD STE 204
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2281
Country	:	US
Telephone Number	:	772-494-7770
Fax Number	:	772-258-4480

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

Provider Enumeration Date	:	02/14/2023
Last Update Date	:	07/24/2025

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