Provider Demographics
NPI:1285023317
Name:MICHELLE ASENCIO LMHC, LLC
Entity Type:Organization
Organization Name:MICHELLE ASENCIO LMHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-459-2909
Mailing Address - Street 1:6200 METROWEST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7636
Mailing Address - Country:US
Mailing Address - Phone:352-459-2909
Mailing Address - Fax:
Practice Address - Street 1:6200 METROWEST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7636
Practice Address - Country:US
Practice Address - Phone:352-459-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12519101YM0800X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty