Provider Demographics
NPI:1679246391
Name:MICHALAK, BETH ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:MICHALAK
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 1:611 W BAY ST STE 1H
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2703
Mailing Address - Country:US
Mailing Address - Phone:716-679-6377
Mailing Address - Fax:
Practice Address - Street 1:611 W BAY ST STE 1H
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2703
Practice Address - Country:US
Practice Address - Phone:727-228-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health