Provider Demographics
NPI:1154676245
Name:RICE, JENNY M
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:M
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 TITKOS DR
Mailing Address - Street 2:#103
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-3317
Mailing Address - Country:US
Mailing Address - Phone:407-409-4919
Mailing Address - Fax:
Practice Address - Street 1:8413 TITKOS DR
Practice Address - Street 2:#103
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-3317
Practice Address - Country:US
Practice Address - Phone:407-409-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8731101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health