Provider Demographics
NPI:1932755337
Name:GROOT-BEGNAUD, JENI ALLISSUN
Entity type:Individual
Prefix:
First Name:JENI
Middle Name:ALLISSUN
Last Name:GROOT-BEGNAUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3064 S PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5912
Mailing Address - Country:US
Mailing Address - Phone:912-230-6345
Mailing Address - Fax:
Practice Address - Street 1:420 N HALIFAX AVE STE 110
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4189
Practice Address - Country:US
Practice Address - Phone:912-230-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health