Provider Demographics
NPI:1790337285
Name:MCPHAUL, MALISHA LAVETTE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MALISHA
Middle Name:LAVETTE
Last Name:MCPHAUL
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 1:618 E SOUTH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2986
Mailing Address - Country:US
Mailing Address - Phone:407-391-5006
Mailing Address - Fax:
Practice Address - Street 1:618 E SOUTH ST STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2986
Practice Address - Country:US
Practice Address - Phone:407-391-5006
Practice Address - Fax:407-309-0444
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17134251S00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH17134OtherDOH