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Provider Information for 1881187110


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DESARAE JENNINGS-OSGARD LMHC, NCC


Sex: Female

NPI: 1881187110
Last Updated: 2021-05-08
Certification Date: 2021-04-13

Details

NameValue
NPI1881187110
Enumeration Date2018-06-12
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 7990 BAYMEADOWS RD E UNIT 311
JACKSONVILLE, FL 32256-2964
United States

Phone: | Fax:
 
Primary Practice Address 4651 SALISBURY RD STE 400
JACKSONVILLE, FL 32256-6187
United States

Phone: 401-954-3343 | Fax:
 
Secondary Practice Address(es)

10151 DEERWOOD PARK BLVD STE 250
JACKSONVILLE, FL 32256-0566
United States

Phone: 904-209-9534 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthFLMH12705