Provider Demographics
NPI:1912361981
Name:JONES, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 NW 110TH AVE
Mailing Address - Street 2:APT 182
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6418
Mailing Address - Country:US
Mailing Address - Phone:330-348-3297
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 110TH AVE
Practice Address - Street 2:APT 182
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-6418
Practice Address - Country:US
Practice Address - Phone:330-348-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health