Healthcare Provider Details

I. General information

NPI: 1053116327
Provider Name (Legal Business Name): MICHELLE LINDSEY MOEHLMANN LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ALEWIVE PARK RD STE 7
KENNEBUNK ME
04043-6134
US

IV. Provider business mailing address

5 BELFAST LN
KENNEBUNK ME
04043-6187
US

V. Phone/Fax

Practice location:
  • Phone: 219-276-1193
  • Fax:
Mailing address:
  • Phone: 219-276-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL7971
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: