MEDICARE: MR. JOHN RICHARD CROSSFIELD LHMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH4466	FL

General Provider Information

NPI Number	:	1043293111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN RICHARD CROSSFIELD LHMC

Provider Business Mailing Address
First Line	:	1909 BEACH BLVD
Second Line	:	SUITE 201
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-8608
Country	:	US
Telephone Number	:	904-853-5900
Fax Number	:	904-853-5885

Provider Business Practice Location Address
First Line	:	1909 BEACH BLVD
Second Line	:	SUITE 201
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-8608
Country	:	US
Telephone Number	:	904-853-5900
Fax Number	:	904-853-5885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	01/09/2025

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