Provider Demographics
NPI:1598327561
Name:BERGOUIGNAN, JESABEL GARCIA (LMHC, RN)
Entity Type:Individual
Prefix:
First Name:JESABEL
Middle Name:GARCIA
Last Name:BERGOUIGNAN
Suffix:
Gender:F
Credentials:LMHC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14665 SW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5003
Mailing Address - Country:US
Mailing Address - Phone:305-773-3255
Mailing Address - Fax:
Practice Address - Street 1:14665 SW 49TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-5003
Practice Address - Country:US
Practice Address - Phone:305-773-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health