Healthcare Provider Details

I. General information

NPI: 1093631038
Provider Name (Legal Business Name): MICHELLE L SULLIVAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 LOOKOUT PL FL 2
MAITLAND FL
32751-8433
US

IV. Provider business mailing address

237 LOOKOUT PL FL 2
MAITLAND FL
32751-8433
US

V. Phone/Fax

Practice location:
  • Phone: 321-754-4044
  • Fax: 321-203-2512
Mailing address:
  • Phone: 321-754-4044
  • Fax: 321-203-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: