Provider Demographics
NPI:1295062446
Name:FEACHER-JONES, JEAN MARIE (ED D)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:FEACHER-JONES
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S EDGEMON AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-3405
Mailing Address - Country:US
Mailing Address - Phone:407-696-4459
Mailing Address - Fax:
Practice Address - Street 1:601 S EDGEMON AVE
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-3405
Practice Address - Country:US
Practice Address - Phone:407-696-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7074101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLMHC# 7074Medicaid