Healthcare Provider Details

I. General information

NPI: 1669046033
Provider Name (Legal Business Name): MICHELLE ASENCIO LMHC-THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 PARK BRANCH AVE
CLERMONT FL
34711-6235
US

IV. Provider business mailing address

3220 PARK BRANCH AVE
CLERMONT FL
34711-6235
US

V. Phone/Fax

Practice location:
  • Phone: 407-717-1305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ASENCIO DE JESUS
Title or Position: OWNER
Credential:
Phone: 407-717-1305