Healthcare Provider Details

I. General information

NPI: 1881743862
Provider Name (Legal Business Name): JO CISCO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 COUNTY ROAD 220
MIDDLEBURG FL
32068-4357
US

IV. Provider business mailing address

1726 KINGSLEY AVE STE 2
ORANGE PARK FL
32073-4411
US

V. Phone/Fax

Practice location:
  • Phone: 904-291-5561
  • Fax: 904-278-5659
Mailing address:
  • Phone: 904-278-5644
  • Fax: 904-278-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: