Provider Demographics
NPI:1124788773
Name:DE JESUS, GLORYS (LMHC)
Entity type:Individual
Prefix:
First Name:GLORYS
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 W LUMSDEN RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8805
Mailing Address - Country:US
Mailing Address - Phone:813-550-1219
Mailing Address - Fax:727-609-9883
Practice Address - Street 1:776 W LUMSDEN RD STE 7
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8805
Practice Address - Country:US
Practice Address - Phone:813-550-1219
Practice Address - Fax:727-609-9883
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health