MEDICARE: MR. KEVIN GOOLSBY M.A., LMHC, NCC

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
2	101YM0800X	Mental Health Counselor	MH12309	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235350562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN GOOLSBY M.A., LMHC, NCC

Provider Business Mailing Address
First Line	:	9233 REDTAIL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-2811
Country	:	US
Telephone Number	:	904-338-2998
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 PARK STREET STE 202
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-3810
Country	:	US
Telephone Number	:	904-338-2998
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	02/21/2017

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Directions to “ MR. KEVIN GOOLSBY M.A., LMHC, NCC” Practice Location

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