Provider Demographics
NPI:1780053090
Name:POOLE, JENNIFER K (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:POOLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:SEYEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:7529 SW 60TH ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-6481
Mailing Address - Country:US
Mailing Address - Phone:352-231-5072
Mailing Address - Fax:
Practice Address - Street 1:7529 SW 60TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693
Practice Address - Country:US
Practice Address - Phone:352-231-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health