Provider Demographics
NPI:1023383221
Name:JONES, JEANNINE (LMHC)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:JONES
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 1:6533 SOLITAIRE PALM WAY
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2115
Mailing Address - Country:US
Mailing Address - Phone:813-810-7404
Mailing Address - Fax:
Practice Address - Street 1:100 FRANDORSON CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2659
Practice Address - Country:US
Practice Address - Phone:813-810-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health