Healthcare Provider Details

I. General information

NPI: 1073102711
Provider Name (Legal Business Name): MS. B MICHELLE ARCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 SW PALM CITY RD
STUART FL
34994-2820
US

IV. Provider business mailing address

828 SW PALM CITY RD
STUART FL
34994-2820
US

V. Phone/Fax

Practice location:
  • Phone: 724-491-8010
  • Fax:
Mailing address:
  • Phone: 724-491-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: