Doctor Name: | JESSICA LITTLE |
NPI Number: | 1013233998 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMHC |
License Number: | MH11680 |
Business Practice Address: | 1255 Golfview Ave Bartow, FL - 338306736 |
Business Phone Number: | 8635190575 |
Business Fax Number: | 8635829251 |
Mailing Address: | Po Box 1559, BARTOW |
State: | FL |
Postal Code: | 338311559 |
Phone Number: | 8635190575 |
Fax Number: | 8635829251 |
NPI Enumeration Date: | 04/16/2010 |
NPI Last Update Date: | 03/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH11680 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |