Healthcare Provider Details

I. General information

NPI: 1083543466
Provider Name (Legal Business Name): MICHELLE GILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SE FEDERAL HWY STE 120
STUART FL
34994-3802
US

IV. Provider business mailing address

916 NW WATERLILY PL
JENSEN BEACH FL
34957-3508
US

V. Phone/Fax

Practice location:
  • Phone: 772-362-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: