Provider Demographics
NPI:1487245965
Name:CUNNINGHAM, JENNIFER (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8035 17TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3951
Mailing Address - Country:US
Mailing Address - Phone:248-417-1553
Mailing Address - Fax:
Practice Address - Street 1:146 2ND ST N FL USA 2ND
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3328
Practice Address - Country:US
Practice Address - Phone:727-300-1861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE