Provider Demographics
NPI:1497290738
Name:JESSICA CARR, LMHC, LLC
Entity Type:Organization
Organization Name:JESSICA CARR, LMHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ROBERTSON
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC
Authorized Official - Phone:239-895-8146
Mailing Address - Street 1:9200 BONITA BEACH RD SE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4280
Mailing Address - Country:US
Mailing Address - Phone:239-895-8146
Mailing Address - Fax:
Practice Address - Street 1:9200 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 212
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4280
Practice Address - Country:US
Practice Address - Phone:239-895-8146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty