Provider Demographics
NPI:1649977216
Name:BROWN, JENELLA JENESE (MCAP, RMHCI)
Entity type:Individual
Prefix:
First Name:JENELLA
Middle Name:JENESE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MCAP, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 572
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34673-0572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7608 LANCELOT RD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-2635
Practice Address - Country:US
Practice Address - Phone:727-265-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH26964101YM0800X
FLMCAP.0101162101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMH26964OtherREGISTERED MENTAL HEALTH COUNSELOR INTERN
FLMCAP.0101162OtherCERTIFIED MASTER'S LEVEL ADDICTION PROFESSIONAL