Provider Demographics
NPI:1952375933
Name:ESPINOZA, MICHELLE (LMHC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:ESPINOZA
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 1:519 BOULDER ST
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536
Mailing Address - Country:US
Mailing Address - Phone:850-226-7322
Mailing Address - Fax:850-226-7491
Practice Address - Street 1:151 MARY ESTHER BLVD
Practice Address - Street 2:STE 408
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569
Practice Address - Country:US
Practice Address - Phone:850-226-7322
Practice Address - Fax:850-226-7491
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4531101YM0800X
FLMH4531101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761888300Medicaid