Provider Demographics
NPI:1043829153
Name:JENSEN-SHORT, DEBORAH (LMHC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:JENSEN-SHORT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:JENSEN-SHORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:2445 LANE PARK RD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-9648
Mailing Address - Country:US
Mailing Address - Phone:407-304-2622
Mailing Address - Fax:407-583-6497
Practice Address - Street 1:2445 LANE PARK RD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-9648
Practice Address - Country:US
Practice Address - Phone:407-304-2622
Practice Address - Fax:407-583-6497
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health