Provider Demographics
NPI:1801930094
Name:FORAKER, MICHELLE A (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:FORAKER
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 DATURA ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5624
Mailing Address - Country:US
Mailing Address - Phone:561-366-9111
Mailing Address - Fax:561-366-9119
Practice Address - Street 1:224 DATURA ST
Practice Address - Street 2:SUITE 407
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5624
Practice Address - Country:US
Practice Address - Phone:561-366-9111
Practice Address - Fax:561-366-9119
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional