Provider Demographics
NPI:1083858468
Name:MCCALLISTER, JENNIFER P (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:P
Last Name:MCCALLISTER
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 1:1400 N SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3536
Mailing Address - Country:US
Mailing Address - Phone:407-878-9346
Mailing Address - Fax:
Practice Address - Street 1:1075 REGAL POINTE TER
Practice Address - Street 2:APT 215
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-416-8295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 6984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health