Provider Demographics
NPI:1154700680
Name:COUGLER, JESSICA (CAP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COUGLER
Suffix:
Gender:F
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N DISSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2707
Mailing Address - Country:US
Mailing Address - Phone:407-489-7257
Mailing Address - Fax:352-360-6582
Practice Address - Street 1:2018 TALLEY RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3426
Practice Address - Country:US
Practice Address - Phone:352-315-7400
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health