Provider Demographics
NPI:1386935245
Name:SANDELL, JENNY LEE (LMHC, NCC, CCMHC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LEE
Last Name:SANDELL
Suffix:
Gender:F
Credentials:LMHC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65190
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-0004
Mailing Address - Country:US
Mailing Address - Phone:904-602-9802
Mailing Address - Fax:904-621-5113
Practice Address - Street 1:115 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-9035
Practice Address - Country:US
Practice Address - Phone:904-602-9802
Practice Address - Fax:904-621-5113
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10736Medicaid