Provider Demographics
NPI:1417203936
Name:NEVILLE, MICHELLE A (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:NEVILLE
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 1:15660 SAN CARLOS BLVD STE 294
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2889
Mailing Address - Country:US
Mailing Address - Phone:239-338-8069
Mailing Address - Fax:239-433-1626
Practice Address - Street 1:15660 SAN CARLOS BLVD STE 294
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2889
Practice Address - Country:US
Practice Address - Phone:239-338-8069
Practice Address - Fax:239-433-1626
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health