Provider Demographics
NPI:1346618915
Name:LAPHAM, JEFFREY (LMHC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:LAPHAM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 COLLEGE PKWY STE 202-3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5188
Mailing Address - Country:US
Mailing Address - Phone:941-467-2980
Mailing Address - Fax:
Practice Address - Street 1:2655 N AIRPORT RD # 62505
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1430
Practice Address - Country:US
Practice Address - Phone:941-467-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-12
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional