Provider Demographics
NPI:1699079707
Name:PARDONNER, JEFFREY GLEN (LMFT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:GLEN
Last Name:PARDONNER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 LIDO BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3090
Mailing Address - Country:US
Mailing Address - Phone:850-916-1244
Mailing Address - Fax:850-916-1244
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW
Practice Address - Street 2:SUITE B3
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5200
Practice Address - Country:US
Practice Address - Phone:850-862-3772
Practice Address - Fax:850-863-4574
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist