Provider Demographics
NPI:1366630428
Name:JEAN-GILLES, MICHELE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:MARIE
Last Name:JEAN-GILLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 TYLER ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4527
Mailing Address - Country:US
Mailing Address - Phone:954-929-7515
Mailing Address - Fax:954-929-7510
Practice Address - Street 1:1909 TYLER ST
Practice Address - Street 2:SUITE 504
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4527
Practice Address - Country:US
Practice Address - Phone:954-929-7515
Practice Address - Fax:954-929-7510
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767892400Medicaid