MEDICARE: MS. MICHELLE ASENCIO 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

General Provider Information

NPI Number	:	1962635987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE ASENCIO LMHC

Provider Business Mailing Address
First Line	:	3220 PARK BRANCH AVE
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6235
Country	:	US
Telephone Number	:	689-500-7176
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 7TH ST STE 7
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-2190
Country	:	US
Telephone Number	:	689-500-7176
Fax Number	:

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	05/28/2022

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