Provider Demographics
NPI:1225516487
Name:COTHRON, JOHN R (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:COTHRON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S HWY 27
Mailing Address - Street 2:STE 205B
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8067
Mailing Address - Country:US
Mailing Address - Phone:407-949-0214
Mailing Address - Fax:407-284-3466
Practice Address - Street 1:4300 S HWY 27
Practice Address - Street 2:STE 205B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8067
Practice Address - Country:US
Practice Address - Phone:407-949-0214
Practice Address - Fax:407-284-3466
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1008800900Medicaid