Provider Demographics
NPI:1154895456
Name:HANEY, MICHAEL LEE (PHD, NCC, QCS, LMHC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:HANEY
Suffix:
Gender:M
Credentials:PHD, NCC, QCS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 PARSONAGE CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-9432
Mailing Address - Country:US
Mailing Address - Phone:850-933-6915
Mailing Address - Fax:850-422-0900
Practice Address - Street 1:3641 PARSONAGE CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-9432
Practice Address - Country:US
Practice Address - Phone:850-933-6915
Practice Address - Fax:850-422-0900
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty