Provider Demographics
NPI:1639421464
Name:JAEGER, MARK (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:JAEGER
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 1:352 MERRIE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3525
Mailing Address - Country:US
Mailing Address - Phone:407-766-1799
Mailing Address - Fax:407-671-0234
Practice Address - Street 1:1417 N SEMORAN BLVD
Practice Address - Street 2:STE 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3555
Practice Address - Country:US
Practice Address - Phone:407-766-1799
Practice Address - Fax:407-671-0234
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH11432OtherSTATE LICENSE