MEDICARE: MATTHEW WINTHROP GAUNTLETT 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	MH11076	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

General Provider Information

NPI Number	:	1346512522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WINTHROP GAUNTLETT LMHC

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP - PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:	904-244-3199
Fax Number	:	904-244-3425

Provider Business Practice Location Address
First Line	:	6266 DUPONT STATION CT E
Second Line	:	UFJAX - DEPT. OF PSYCHIATRY
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2567
Country	:	US
Telephone Number	:	904-383-1038
Fax Number	:	904-383-1660

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

Provider Enumeration Date	:	02/02/2012
Last Update Date	:	11/07/2013

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