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General NPI Number Information
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NPI Number | 1902077159
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Entity Type | Organization
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Legal Business Name | MICHELLE REARDON,ED.D.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 8206 NW 38TH ST
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-2922
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Country | US
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Telephone | 954-796-7415
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Fax | 954-752-7926
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Provider Business Mailing Address
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Address Line | 8206 NW 38 ST
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City | CORAL SPRINGS
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State | FL
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Zip | 33065
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Country | US
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Telephone | 954-796-7415
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Fax | 954-752-7926
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE REARDON
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Credential | ED.D.
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Telephone | 954-796-7415
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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 | LMHC1607
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License Number State | FL
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