Provider Demographics
NPI:1396165924
Name:WILSON, MICHELE LEE (LMHC, CAP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 PGA BLVD
Mailing Address - Street 2:SUIT 204
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2909
Mailing Address - Country:US
Mailing Address - Phone:561-308-0814
Mailing Address - Fax:
Practice Address - Street 1:2925 PGA BLVD
Practice Address - Street 2:SUIT 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2909
Practice Address - Country:US
Practice Address - Phone:561-308-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health