Provider Demographics
NPI:1891389003
Name:NYMAN, JUSTINE (LMHC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:NYMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9037 KING RD W
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-3708
Mailing Address - Country:US
Mailing Address - Phone:973-270-7089
Mailing Address - Fax:
Practice Address - Street 1:9037 KING RD W
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-3708
Practice Address - Country:US
Practice Address - Phone:973-270-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-28
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health