Provider Demographics
NPI:1194916270
Name:ELLIOTT, JENIFER JOHNSTON (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:JOHNSTON
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:LEE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 320284
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2284
Mailing Address - Country:US
Mailing Address - Phone:813-767-9358
Mailing Address - Fax:
Practice Address - Street 1:200 S HOOVER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3540
Practice Address - Country:US
Practice Address - Phone:813-767-9358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist