Provider Demographics
NPI:1982762951
Name:SIMPSON, JEANIE KENLY (MS, LMHC, CAP, NCC)
Entity Type:Individual
Prefix:MS
First Name:JEANIE
Middle Name:KENLY
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS, LMHC, CAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NE 1ST PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-4246
Mailing Address - Country:US
Mailing Address - Phone:239-281-1998
Mailing Address - Fax:
Practice Address - Street 1:923 DEL PRADO BLVD S
Practice Address - Street 2:SUITE 205
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3652
Practice Address - Country:US
Practice Address - Phone:239-281-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1630101YA0400X
FLMH6192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ113UOtherBCBS OF FL