Provider Demographics
NPI:1518599521
Name:LORI MICHELS, LLC
Entity Type:Organization
Organization Name:LORI MICHELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CST, S-PSB
Authorized Official - Phone:203-676-2796
Mailing Address - Street 1:209 S COOPERS HAWK WAY
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2328
Mailing Address - Country:US
Mailing Address - Phone:203-676-2796
Mailing Address - Fax:
Practice Address - Street 1:209 S COOPERS HAWK WAY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2328
Practice Address - Country:US
Practice Address - Phone:203-676-2796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty