MEDICARE: JONATHAN VAUGHN PAWSON 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	20750	FL
2	101YM0800X	Mental Health Counselor	MH22027	FL

General Provider Information

NPI Number	:	1205548542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN VAUGHN PAWSON LMHC

Provider Business Mailing Address
First Line	:	7683 DEER FOOT DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-5004
Country	:	US
Telephone Number	:	541-788-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	7683 DEER FOOT DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-5004
Country	:	US
Telephone Number	:	541-788-0079
Fax Number	:

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

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	08/01/2023

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