Provider Demographics
NPI:1639785116
Name:RAE CHILDERS SKRMETTA, MICHELE (LMHC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:RAE CHILDERS SKRMETTA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:CHILDERS SKRMETTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:11021 RIVER TRENT CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-3739
Mailing Address - Country:US
Mailing Address - Phone:918-636-4890
Mailing Address - Fax:
Practice Address - Street 1:9241 PARK ROYAL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9204
Practice Address - Country:US
Practice Address - Phone:239-985-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17251101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health