Active NPI
Carlos Alberto Jazan, LMHC
- Mental Health Counselor
- Gulf Breeze, FL
National Provider Identifier
1396033874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH3744
- Practice address
- 4038 Sandy Bluff Dr W
Gulf Breeze, FL 32563-2938 - Phone
- (850) 665-3599
- Fax
- (850) 665-3599
- NPI assigned
- Jul 18, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | MH3744 | FL | Primary |
Addresses
Primary practice location
4038 Sandy Bluff Dr W
Gulf Breeze, FL 32563-2938
Mailing address
PO Box 838
Gulf Breeze, FL 32562-0838
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH3744 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362441600000",
"number": "1396033874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 838",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325620838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4038 SANDY BLUFF DR W",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325632938",
"telephone_number": "850-665-3599",
"fax_number": "850-665-3599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAZAN",
"first_name": "CARLOS",
"middle_name": "ALBERTO",
"name_prefix": "Mr.",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-18",
"last_updated": "2013-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH3744",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulf Breeze, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.