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JO CISCO LMHC

>> Case Manager/Care Coordinator >> Other Service Providers

Registrant NPI Number: 1881743862

Individual Registrant:
 JO  CISCO LMHC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
3292 COUNTY ROAD 220  MIDDLEBURG, FL 32068-4357 US
Tel: 904-291-5561  Fax: 904-278-5659

Contact information for business:
1726 KINGSLEY AVE STE 2  ORANGE PARK, FL 32073-4411 US
Tel: 904-278-5644  Fax: 904-278-5659

Registration Information:
NPI: 1881743862
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
X171M00000XOther Service Providers
Case Manager/Care Coordinator
X101YM0800XBehavioral Health & Social Service Providers
Counselor
FLMH5101

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
BLUECROSSZ9156FL01




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