Provider Demographics
NPI:1841548419
Name:CELANI, JENNIFER (LPCA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CELANI
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 LAKE PARKE DR
Mailing Address - Street 2:SUITE 21
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3022
Mailing Address - Country:US
Mailing Address - Phone:504-919-3902
Mailing Address - Fax:
Practice Address - Street 1:1136 LAKE PARKE DR
Practice Address - Street 2:SUITE 21
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3022
Practice Address - Country:US
Practice Address - Phone:504-919-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health