Provider Demographics
NPI:1619989522
Name:WARE, JEFF (LMHC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:WARE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3904
Mailing Address - Country:US
Mailing Address - Phone:863-294-7062
Mailing Address - Fax:
Practice Address - Street 1:1201 FIRST STREET
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-294-7062
Practice Address - Fax:863-291-6084
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766632200Medicaid