Provider Demographics
NPI:1174804819
Name:NELSON, JENNY CALVAR (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:CALVAR
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 MICHIGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1933
Mailing Address - Country:US
Mailing Address - Phone:407-846-5285
Mailing Address - Fax:
Practice Address - Street 1:2540 MICHIGAN AVE STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1933
Practice Address - Country:US
Practice Address - Phone:407-846-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health