Provider Demographics
NPI:1003466400
Name:PIERRE-LYS, JENNIFER (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PIERRE-LYS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 S DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-2573
Mailing Address - Country:US
Mailing Address - Phone:407-353-2728
Mailing Address - Fax:
Practice Address - Street 1:1703 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7000
Practice Address - Country:US
Practice Address - Phone:407-219-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health