Provider Demographics
NPI:1427419910
Name:MIKELL, LEE (LMHC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:MIKELL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11265 ALUMNI WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6685
Mailing Address - Country:US
Mailing Address - Phone:904-398-2020
Mailing Address - Fax:
Practice Address - Street 1:11265 ALUMNI WAY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6685
Practice Address - Country:US
Practice Address - Phone:904-398-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health