MEDICARE: MS. MICHELLE ESPINOZA 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 4531	FL
2	101Y00000X	Counselor	MH4531	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952375933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE ESPINOZA LMHC

Provider Business Mailing Address
First Line	:	519 BOULDER ST
Second Line	:
City	:	CRESTVIEW
State	:	FL
Zip	:	32536
Country	:	US
Telephone Number	:	850-226-7322
Fax Number	:	850-226-7491

Provider Business Practice Location Address
First Line	:	151 MARY ESTHER BLVD
Second Line	:	STE 408
City	:	MARY ESTHER
State	:	FL
Zip	:	32569
Country	:	US
Telephone Number	:	850-226-7322
Fax Number	:	850-226-7491

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/06/2011

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