MEDICARE: MS. MICHELLE SOARES PEREIRA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH22153	FL

General Provider Information

NPI Number	:	1164152583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE SOARES PEREIRA LMHC

Provider Business Mailing Address
First Line	:	10163 FORTUNE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3519
Country	:	US
Telephone Number	:	904-749-3869
Fax Number	:	904-644-3299

Provider Business Practice Location Address
First Line	:	10163 FORTUNE PKWY
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3519
Country	:	US
Telephone Number	:	904-749-3869
Fax Number	:	904-633-3299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	04/06/2026

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