MEDICARE: MR. JONATHAN CRAIG BOYDSTON LCSW

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	1041C0700X	Clinical Social Worker	SW 1874	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	:	1629042080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN CRAIG BOYDSTON LCSW

Provider Business Mailing Address
First Line	:	13936 GROVER RD.
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-5063
Country	:	US
Telephone Number	:	850-855-8601
Fax Number	:

Provider Business Practice Location Address
First Line	:	13936 GROVER RD.
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-5063
Country	:	US
Telephone Number	:	850-855-8601
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/25/2023

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Directions to “ MR. JONATHAN CRAIG BOYDSTON LCSW” Practice Location

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