Provider Demographics
NPI:1639547110
Name:SHAFFER, JENNA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-973-1304
Mailing Address - Fax:813-355-5024
Practice Address - Street 1:2237 TWELVE OAKS WAY
Practice Address - Street 2:STE 103
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6983
Practice Address - Country:US
Practice Address - Phone:813-973-1304
Practice Address - Fax:813-355-5024
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12899101YM0800X
FLMT2936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist