Provider Demographics
NPI:1265622500
Name:WELDON, JEAN (LMHC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:WELDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5324
Mailing Address - Country:US
Mailing Address - Phone:321-480-3710
Mailing Address - Fax:
Practice Address - Street 1:1900 BUILDING E. NEW HAVEN AVE
Practice Address - Street 2:SUITE 223
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:321-480-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0008962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health