Provider Demographics
NPI:1407159122
Name:CORREA, JENNIFER ORTIZ (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ORTIZ
Last Name:CORREA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, IMH
Mailing Address - Street 1:2335 NW 10TH ST
Mailing Address - Street 2:UNIT 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-5348
Mailing Address - Country:US
Mailing Address - Phone:352-301-7902
Mailing Address - Fax:352-354-9191
Practice Address - Street 1:2335 NW 10TH ST
Practice Address - Street 2:UNIT 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-5348
Practice Address - Country:US
Practice Address - Phone:352-301-7902
Practice Address - Fax:352-354-9191
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health