Provider Demographics
NPI:1245317460
Name:STAPLETON, RICHARD MICHAEL JR (LMHC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MICHAEL
Last Name:STAPLETON
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:STAPLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:6097 CALADESI CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1168
Mailing Address - Country:US
Mailing Address - Phone:904-502-1952
Mailing Address - Fax:904-260-8418
Practice Address - Street 1:6097 CALADESI CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-1168
Practice Address - Country:US
Practice Address - Phone:904-502-1952
Practice Address - Fax:904-260-8418
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7103101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763885000Medicaid