Provider Demographics
NPI:1497162481
Name:JENNIFER A. MANNION
Entity Type:Organization
Organization Name:JENNIFER A. MANNION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANNION
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC
Authorized Official - Phone:813-731-6954
Mailing Address - Street 1:1219 MILLENNIUM PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3879
Mailing Address - Country:US
Mailing Address - Phone:813-731-6954
Mailing Address - Fax:813-413-6758
Practice Address - Street 1:1219 MILLENNIUM PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3879
Practice Address - Country:US
Practice Address - Phone:813-731-6954
Practice Address - Fax:813-413-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty