Provider Demographics
NPI:1467793935
Name:COELLO, JENNY (MS, LMHC, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:COELLO
Suffix:
Gender:F
Credentials:MS, LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103530 OVERSEAS HWY # 1635
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2839
Mailing Address - Country:US
Mailing Address - Phone:786-333-2975
Mailing Address - Fax:
Practice Address - Street 1:103530 OVERSEAS HWY # 1635
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2839
Practice Address - Country:US
Practice Address - Phone:786-333-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13886101YM0800X
1-18-33141103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019661500Medicaid