Provider Demographics
NPI:1689034753
Name:MICHELIN, MELISSA (LMFT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MICHELIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 NW 91ST AVE APT 1137
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6697
Mailing Address - Country:US
Mailing Address - Phone:215-760-4819
Mailing Address - Fax:
Practice Address - Street 1:4200 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6210
Practice Address - Country:US
Practice Address - Phone:954-618-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2420106H00000X
FLMT3421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist