Healthcare Provider Details

I. General information

NPI: 1306035787
Provider Name (Legal Business Name): REBECCA MARTIN LACHUT LMHC LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4595 LEXINGTON AVE
JACKSONVILLE FL
32210-2058
US

IV. Provider business mailing address

4595 LEXINGTON AVE
JACKSONVILLE FL
32210-2058
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-4700
  • Fax: 904-783-1901
Mailing address:
  • Phone: 904-448-4700
  • Fax: 904-783-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 2468
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 10072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: