Healthcare Provider Details

I. General information

NPI: 1306623400
Provider Name (Legal Business Name): ANN CAUGHMAN LMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/16/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 ROUNDTREE CIR
ST JOHNS FL
32259-1929
US

IV. Provider business mailing address

1101 ROUNDTREE CIR
ST JOHNS FL
32259-1929
US

V. Phone/Fax

Practice location:
  • Phone: 904-510-8705
  • Fax:
Mailing address:
  • Phone: 904-510-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMPC
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH18124
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberORDAINED
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: