MEDICARE: MR. ANDREW ROBERT MICHAELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	007765	NY
2	101YP2500X	Professional Counselor	7232	SC

General Provider Information

NPI Number	:	1033645163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW ROBERT MICHAELS

Provider Business Mailing Address
First Line	:	2320 MARGARITA DR UNIT 8201
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2053
Country	:	US
Telephone Number	:	516-637-9204
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 MARGARITA DR UNIT 8201
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2053
Country	:	US
Telephone Number	:	516-637-9204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	04/23/2026

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