MEDICARE: KASSANDRA SHUGARS MCCUNE LMHC

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	MH10498	FL

General Provider Information

NPI Number	:	1043488349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSANDRA SHUGARS MCCUNE LMHC

Provider Business Mailing Address
First Line	:	120 HAWTHORNE RD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-6612
Country	:	US
Telephone Number	:	904-392-9188
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 HAWTHORNE RD
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32086-6612
Country	:	US
Telephone Number	:	904-392-9188
Fax Number	:

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	12/13/2024

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