Provider Demographics
NPI:1528018280
Name:FORSYTHE, MICHELLE LOIS (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOIS
Last Name:FORSYTHE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 NE 28TH CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-2171
Mailing Address - Country:US
Mailing Address - Phone:352-624-3307
Mailing Address - Fax:352-622-1017
Practice Address - Street 1:1644 NE 22ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4727
Practice Address - Country:US
Practice Address - Phone:352-624-3307
Practice Address - Fax:352-622-1017
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7412101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health