MEDICARE: MS. MICHELLE GENESE THOMPSON 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	MH9875	FL

General Provider Information

NPI Number	:	1740599349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE GENESE THOMPSON LMHC

Provider Business Mailing Address
First Line	:	1919 VAN BUREN ST
Second Line	:	720A
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-7810
Country	:	US
Telephone Number	:	305-761-3903
Fax Number	:	954-924-4572

Provider Business Practice Location Address
First Line	:	1919 VAN BUREN ST
Second Line	:	720A
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-7810
Country	:	US
Telephone Number	:	305-761-3903
Fax Number	:	954-924-4572

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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