Provider Demographics
NPI:1053435206
Name:JEAN-CHARLES, JO MYRTHO (LMHC)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:MYRTHO
Last Name:JEAN-CHARLES
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 1:950 S PINE ISLAND RD STE 150A
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3918
Mailing Address - Country:US
Mailing Address - Phone:954-632-1983
Mailing Address - Fax:
Practice Address - Street 1:950 S PINE ISLAND RD
Practice Address - Street 2:SUITE A150
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3918
Practice Address - Country:US
Practice Address - Phone:954-632-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768215800Medicaid