Provider Demographics
NPI:1114686508
Name:JEFFERSON, JESSICA (LMFT, PMH-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LMFT, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2072
Mailing Address - Country:US
Mailing Address - Phone:954-317-9460
Mailing Address - Fax:
Practice Address - Street 1:8016 WILES RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2072
Practice Address - Country:US
Practice Address - Phone:954-317-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3833106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist