Provider Demographics
NPI:1396033874
Name:JAZAN, CARLOS ALBERTO (LMHC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:JAZAN
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:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32562-0838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4038 SANDY BLUFF DR W
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2938
Practice Address - Country:US
Practice Address - Phone:850-665-3599
Practice Address - Fax:850-665-3599
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health