Provider Demographics
NPI:1568517522
Name:DWYER, MICHAEL VINCENT (EDD, LCMHC, LCPS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:DWYER
Suffix:
Gender:M
Credentials:EDD, LCMHC, LCPS
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:V
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD, LPC-S, LCMHC
Mailing Address - Street 1:109 RAINBOW DR # 939
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-1009
Mailing Address - Country:US
Mailing Address - Phone:352-410-5552
Mailing Address - Fax:
Practice Address - Street 1:2474 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:BARKSDALE AIR FORCE BASE
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:352-410-5552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL125924101YA0400X
MA11206101YM0800X
NHEL11259101YM0800X
LA8997101YP2500X
MECC4401101YP2500X
FLMH8348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health