Healthcare Provider Details

I. General information

NPI: 1285023317
Provider Name (Legal Business Name): MICHELLE ASENCIO LMHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 METROWEST BLVD SUITE 202
ORLANDO FL
32835-7636
US

IV. Provider business mailing address

6200 METROWEST BLVD SUITE 202
ORLANDO FL
32835-7636
US

V. Phone/Fax

Practice location:
  • Phone: 352-459-2909
  • Fax:
Mailing address:
  • Phone: 352-459-2909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12519
License Number StateFL

VIII. Authorized Official

Name: MRS. MICHELLE ASENCIO
Title or Position: THERAPIST/OWNER
Credential: LMHC
Phone: 352-459-2909