MEDICARE: MR. JASON AXFORD 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	MH15659	FL

General Provider Information

NPI Number	:	1861151102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON AXFORD LMHC

Provider Business Mailing Address
First Line	:	17924 TIMBER VIEW ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2949
Country	:	US
Telephone Number	:	540-421-5004
Fax Number	:

Provider Business Practice Location Address
First Line	:	17924 TIMBER VIEW ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2949
Country	:	US
Telephone Number	:	540-421-5004
Fax Number	:

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

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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