MEDICARE: CHERRY LOFTON

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	101YP2500X	Professional Counselor	BBH-LCPC-LIC-80083	MT
2	101YM0800X	Mental Health Counselor	MH24410	FL

General Provider Information

NPI Number	:	1558015537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERRY LOFTON

Provider Business Mailing Address
First Line	:	11333 LANDING ESTATES DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1544
Country	:	US
Telephone Number	:	904-521-2319
Fax Number	:

Provider Business Practice Location Address
First Line	:	11333 LANDING ESTATES DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1544
Country	:	US
Telephone Number	:	904-521-2319
Fax Number	:

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

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	03/17/2026

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Directions to “ CHERRY LOFTON ” Practice Location

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