Provider Demographics
NPI:1629463526
Name:JOHN RICHARD CROSSFIELD, LMHC, MAC, PA
Entity Type:Organization
Organization Name:JOHN RICHARD CROSSFIELD, LMHC, MAC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-853-5900
Mailing Address - Street 1:1909 BEACH BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2643
Mailing Address - Country:US
Mailing Address - Phone:904-853-5900
Mailing Address - Fax:904-853-5885
Practice Address - Street 1:1909 BEACH BLVD STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2643
Practice Address - Country:US
Practice Address - Phone:904-853-5900
Practice Address - Fax:904-853-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty