Provider Demographics
NPI:1114230034
Name:MOORE, MICHELLE SUSANNE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SUSANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 PATEL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8701
Mailing Address - Country:US
Mailing Address - Phone:407-574-8056
Mailing Address - Fax:407-574-5578
Practice Address - Street 1:23 N SUMMERLIN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2900
Practice Address - Country:US
Practice Address - Phone:407-574-8056
Practice Address - Fax:407-574-5578
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health