Provider Demographics
NPI:1023525466
Name:GROOMS, JANIS DEE
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:DEE
Last Name:GROOMS
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 1:2350 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8825
Mailing Address - Country:US
Mailing Address - Phone:727-415-7777
Mailing Address - Fax:
Practice Address - Street 1:9160 OAKHURST RD STE 3B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776
Practice Address - Country:US
Practice Address - Phone:727-240-1922
Practice Address - Fax:727-240-1928
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health