Provider Demographics
NPI:1013115773
Name:MANNION, JENNIFER A (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MANNION
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10724 SHADY PRESERVE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-9312
Mailing Address - Country:US
Mailing Address - Phone:813-731-6954
Mailing Address - Fax:
Practice Address - Street 1:10921 MCMULLEN LOOP
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5100
Practice Address - Country:US
Practice Address - Phone:813-731-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health