Provider Demographics
NPI:1003450289
Name:REICHARD, MICHELLE T (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:REICHARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 NW 77TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1590
Mailing Address - Country:US
Mailing Address - Phone:786-916-6073
Mailing Address - Fax:786-657-3092
Practice Address - Street 1:14400 NW 77TH CT STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1590
Practice Address - Country:US
Practice Address - Phone:786-916-6073
Practice Address - Fax:786-657-3092
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104755700Medicaid