Provider Demographics
NPI:1457955437
Name:HAYNES, JENNIFER ELAINE (LMHC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:HAYNES
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 1:1995 SW NEWPORT ISLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4382
Mailing Address - Country:US
Mailing Address - Phone:772-877-5756
Mailing Address - Fax:
Practice Address - Street 1:1995 SW NEWPORT ISLES BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4382
Practice Address - Country:US
Practice Address - Phone:772-307-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH20058101YM0800X
FLMH22103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health