Provider Demographics
NPI:1558890392
Name:J-NISSI'S THERAPY & COUNSELING LLC
Entity Type:Organization
Organization Name:J-NISSI'S THERAPY & COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:903-304-3800
Mailing Address - Street 1:1536 KINGSLEY AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4525
Mailing Address - Country:US
Mailing Address - Phone:904-304-3800
Mailing Address - Fax:904-644-7123
Practice Address - Street 1:1536 KINGSLEY AVE STE 120
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4525
Practice Address - Country:US
Practice Address - Phone:904-304-3800
Practice Address - Fax:904-644-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH11462OtherFLORIDA DEPARTMENT HEALTH
FL007347100Medicaid
FL5901OtherFLORIDA CERTIFICATION BOARD