MEDICARE: MRS. RACHEL PATRICIA WITTOSCH 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		FL
2	101YM0800X	Mental Health Counselor	MH16838	FL

General Provider Information

NPI Number	:	1336758283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL PATRICIA WITTOSCH LMHC

Provider Business Mailing Address
First Line	:	2121 CORPORATE SQUARE BLVD STE 124
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1977
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 CORPORATE SQUARE BLVD STE 124
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1977
Country	:	US
Telephone Number	:	904-207-7973
Fax Number	:

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

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	10/07/2021

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