Provider Demographics
NPI:1447523790
Name:RICE, JEFFREY EDGAR (LMHC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EDGAR
Last Name:RICE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30300 SW 171ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3420
Mailing Address - Country:US
Mailing Address - Phone:305-423-6385
Mailing Address - Fax:305-508-6592
Practice Address - Street 1:1005 N KROME AVE
Practice Address - Street 2:SUITE#121
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4462
Practice Address - Country:US
Practice Address - Phone:305-484-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2023-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11127101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013951200Medicaid