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General NPI Number Information
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NPI Number | 1205231404
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Entity Type | Organization
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Legal Business Name | MICHELE L WILSON
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 400 VILLAGE SQUARE XING SUITE 2
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3227
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Country | US
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Telephone | 561-308-0814
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Fax | 561-444-4444
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Provider Business Mailing Address
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Address Line | 6054 HOLLYWOOD STREET
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City | JUPITER
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State | FL
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Zip | 33458-6724
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Country | US
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Telephone | 561-308-0814
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Fax | 561-444-4444
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Authorized Official
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Title or Position | PROVIDER & OWNER
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Name | MICHELE L WILSON
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Credential | LMHC CAP
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Telephone | 561-308-0814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH12108
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License Number State | FL
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