Jacob C Crouch, III, LMHC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

MH3311 Issued in FL

Practice address

7448 Culver Lane
New Port Richey, FL 34655-3433

Phone

(727) 858-9183

NPI assigned

Mar 24, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1043960073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7448 CULVER LANE",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346553433",
            "telephone_number": "727-858-9183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7448 CULVER LANE",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346553433",
            "telephone_number": "727-858-9183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROUCH, III",
        "first_name": "JACOB",
        "middle_name": "C",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-24",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "FL",
            "license": "MH3311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marielyne P Cuomo, L/PTA

• Counselor in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.