Jeanette Provenza I

NPI #1710334008 in Lutz, Florida

Provider Information

NPI Number: 1710334008
Entity Type: Individual
Name: Jeanette Provenza I
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Mental Health
Enumeration Date: May 17, 2016
Last Updated: May 17, 2016

Practice Location

Address: 1515 MICHELIN CT
City: Lutz
State: Florida
ZIP Code: 33549-7533
Phone: (813) 949-3904

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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