Provider Demographics
NPI:1184844623
Name:BURCH, JENNIFER CHARLYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHARLYNN
Last Name:BURCH
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 1:276 BRAZILIAN CIR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1398
Mailing Address - Country:US
Mailing Address - Phone:321-474-5660
Mailing Address - Fax:772-337-8505
Practice Address - Street 1:1497 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2802
Practice Address - Country:US
Practice Address - Phone:772-337-8500
Practice Address - Fax:772-337-8505
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14313101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist