Provider Demographics
NPI:1538196357
Name:KRATOCHVIL, MICHELE ROSA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ROSA
Last Name:KRATOCHVIL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1781 ADMIRAL CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6601
Mailing Address - Country:US
Mailing Address - Phone:407-870-2223
Mailing Address - Fax:407-870-0035
Practice Address - Street 1:16 N CLYDE AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5420
Practice Address - Country:US
Practice Address - Phone:407-870-2223
Practice Address - Fax:407-870-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5310101YM0800X
FLMA9804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001089800Medicaid