Provider Demographics
NPI:1871998393
Name:GOSDEN, JENNA NICOLE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:NICOLE
Last Name:GOSDEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2534
Mailing Address - Country:US
Mailing Address - Phone:904-387-4461
Mailing Address - Fax:904-384-5753
Practice Address - Street 1:2892 FORBES ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7572
Practice Address - Country:US
Practice Address - Phone:717-919-1725
Practice Address - Fax:904-384-5753
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health