Provider Demographics
NPI:1669688123
Name:KLEMZAK, JAMIE RENEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:RENEE
Last Name:KLEMZAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:RENEE
Other - Last Name:KLEMZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2309 49TH STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707
Mailing Address - Country:US
Mailing Address - Phone:727-300-6790
Mailing Address - Fax:
Practice Address - Street 1:2309 49TH ST S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-5139
Practice Address - Country:US
Practice Address - Phone:727-300-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP0101021101YA0400X
FLMT2204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT2204OtherMFT LICENSURE