Healthcare Provider Details

I. General information

NPI: 1700037736
Provider Name (Legal Business Name): SANDRA D. MOENSSENS LMHC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA BIRKELBACH LYNCH

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 06/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17307 PAGONIA RD SUITE 100
CLERMONT FL
34711
US

IV. Provider business mailing address

17307 PAGONIA RD SUITE 100
CLERMONT FL
34711
US

V. Phone/Fax

Practice location:
  • Phone: 321-230-0740
  • Fax: 352-577-8972
Mailing address:
  • Phone: 321-230-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9675
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: