Individual
MRS. MICHELE LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS-MFT
Contact information
Practice address
10659 NW SR 20, BRISTOL, FL 32321
(859) 492-6177
Mailing address
2817 MAGNOLIA BLOSSOM LN, MARIANNA, FL 32446-6395
(859) 492-6177
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/19/2019
Last updated
04/19/2019
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