Provider Demographics
NPI:1104098417
Name:LYNCH, MICHELLE (SHELLEY) A (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE (SHELLEY)
Middle Name:A
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 N MAITLAND AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4783
Mailing Address - Country:US
Mailing Address - Phone:407-647-5448
Mailing Address - Fax:
Practice Address - Street 1:341 N MAITLAND AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4783
Practice Address - Country:US
Practice Address - Phone:407-647-5448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4585101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health