Provider Demographics
NPI:1174657068
Name:CHESNUT, JASON D (MS, LMHC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:D
Last Name:CHESNUT
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6021
Mailing Address - Country:US
Mailing Address - Phone:407-957-4176
Mailing Address - Fax:407-957-4359
Practice Address - Street 1:3112 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6021
Practice Address - Country:US
Practice Address - Phone:407-957-4176
Practice Address - Fax:407-957-4359
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6331101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health