Provider Demographics
NPI:1942547583
Name:KIEZER-ROLES, MICHELLINE KAREN (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLINE
Middle Name:KAREN
Last Name:KIEZER-ROLES
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 1:3741 NW 95TH TER APT 1503
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6481
Mailing Address - Country:US
Mailing Address - Phone:954-408-4184
Mailing Address - Fax:
Practice Address - Street 1:3741 NW 95TH TER APT 1503
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6481
Practice Address - Country:US
Practice Address - Phone:954-408-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3663106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist