MEDICARE: MR. MICHAEL E SPENCER LMHC

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	MH 8302	FL

General Provider Information

NPI Number	:	1073562625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL E SPENCER LMHC

Provider Business Mailing Address
First Line	:	4290 COREY RD
Second Line	:
City	:	MALABAR
State	:	FL
Zip	:	32950-4305
Country	:	US
Telephone Number	:	321-727-7325
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 W EAU GALLIE BLVD
Second Line	:	SUITE 200
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7213
Country	:	US
Telephone Number	:	321-752-3100
Fax Number	:	321-752-3234

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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