Provider Demographics
NPI:1205986684
Name:JABICK, JEFFREY GLENN (LMHC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GLENN
Last Name:JABICK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 W BROWARD BLVD # 148
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2351
Mailing Address - Country:US
Mailing Address - Phone:954-424-6119
Mailing Address - Fax:954-585-0177
Practice Address - Street 1:7372 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1605
Practice Address - Country:US
Practice Address - Phone:954-424-6119
Practice Address - Fax:954-585-0177
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health