Provider Demographics
NPI:1386879732
Name:MANCHESTER, MICHAEL WARREN (MA, NCC, LMHC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WARREN
Last Name:MANCHESTER
Suffix:
Gender:M
Credentials:MA, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 S OSCEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1350
Mailing Address - Country:US
Mailing Address - Phone:407-324-7979
Mailing Address - Fax:407-324-7901
Practice Address - Street 1:3074 W LAKE MARY BLVD
Practice Address - Street 2:140
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6749
Practice Address - Country:US
Practice Address - Phone:407-324-7979
Practice Address - Fax:407-324-7901
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9898101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional