Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003143710 |
---|---|
Provider Name | Jennifer Lantz Colling |
First Address | West Palm Beach, FL 33409 |
Second Address | West Palm Beach, FL 33409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2009 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z04ZR | FLORIDA BLUE (01) | FL |