Provider Demographics
NPI:1972231686
Name:LE, JEFFREY NGUYEN (MS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:NGUYEN
Last Name:LE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7040
Mailing Address - Country:US
Mailing Address - Phone:352-348-4195
Mailing Address - Fax:
Practice Address - Street 1:750 S ORLANDO AVE STE 201
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4872
Practice Address - Country:US
Practice Address - Phone:321-527-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health