Provider Demographics
NPI:1790517670
Name:PETRELLA, JENNA (LMFT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:PETRELLA
Suffix:
Gender:
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W DR MARTIN LUTHER KING JR BLVD # 236
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3309
Mailing Address - Country:US
Mailing Address - Phone:813-758-8902
Mailing Address - Fax:
Practice Address - Street 1:829 W DR MARTIN LUTHER KING JR BLVD # 236
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3309
Practice Address - Country:US
Practice Address - Phone:813-758-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT5009101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health