MEDICARE: MRS. JENNIFER M. ADAIR LCPC

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	LH60978127	WA
2	101YM0800X	Mental Health Counselor	MH15513	FL
3	101YP2500X	Professional Counselor	XL3385	ME
4	101YP2500X	Professional Counselor	CC3699	ME

General Provider Information

NPI Number	:	1770883167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER M. ADAIR LCPC

Provider Business Mailing Address
First Line	:	2707 VIA SANTA CROCE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5567
Country	:	US
Telephone Number	:	845-489-6875
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 VIA SANTA CROCE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5567
Country	:	US
Telephone Number	:	184-548-9687
Fax Number	:

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

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	04/11/2021

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