Provider Demographics
NPI:1144438466
Name:AYRES, JEAN SHIRELY (MA, LMHC, LLP, LPC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:SHIRELY
Last Name:AYRES
Suffix:
Gender:F
Credentials:MA, LMHC, LLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9626 LAKE CHRISTINA LN
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3927
Mailing Address - Country:US
Mailing Address - Phone:727-487-1816
Mailing Address - Fax:727-487-1816
Practice Address - Street 1:9626 LAKE CHRISTINA LN
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3927
Practice Address - Country:US
Practice Address - Phone:727-487-1816
Practice Address - Fax:727-487-1816
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLH7676101YM0800X
MILLP6301008490101YM0800X
MILPC6401003612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional