Provider Demographics
NPI:1750637401
Name:SOUSA, JAMIE LYNNE (LMHC, CTRS-BH, CYFI)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LYNNE
Last Name:SOUSA
Suffix:
Gender:F
Credentials:LMHC, CTRS-BH, CYFI
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:LYNNE
Other - Last Name:WARGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1667 39TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3635
Mailing Address - Country:US
Mailing Address - Phone:412-721-6999
Mailing Address - Fax:
Practice Address - Street 1:1645 PALM BEACH LAKES BLVD STE 1200
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2214
Practice Address - Country:US
Practice Address - Phone:412-721-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health