Provider Demographics
NPI:1720135130
Name:GAINSLEY, JEFFERY L (DMIN LMFT)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:L
Last Name:GAINSLEY
Suffix:
Gender:M
Credentials:DMIN LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36338 W SPRING LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5309
Mailing Address - Country:US
Mailing Address - Phone:352-326-9120
Mailing Address - Fax:352-326-9120
Practice Address - Street 1:110 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5167
Practice Address - Country:US
Practice Address - Phone:352-326-9120
Practice Address - Fax:352-326-9120
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist