MEDICARE: JOHN RICHARD CROSSFIELD, LMHC, MAC, PA

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	MH4466	FL

General Provider Information

NPI Number	:	1629463526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN RICHARD CROSSFIELD, LMHC, MAC, PA

Provider Business Mailing Address
First Line	:	1909 BEACH BLVD STE 201
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2643
Country	:	US
Telephone Number	:	904-853-5900
Fax Number	:	904-853-5885

Provider Business Practice Location Address
First Line	:	1909 BEACH BLVD STE 201
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2643
Country	:	US
Telephone Number	:	904-853-5900
Fax Number	:	904-853-5885

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN CROSSFIELD
Credential	:	LMHC
Telephone Number	:	904-853-5900

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	03/30/2015

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