Michael Vincent Dwyer, EDD, LCMHC, LCPS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

MH8348 Issued in FL

Practice address

2474 Princeton Dr
Barksdale Air Force Base, LA 71111

Phone

(352) 410-5552

NPI assigned

Jan 23, 2007

Last updated

Mar 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Other names 1

• Dr. Mike V Dwyer Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lifestream Behavioral Center Inc

  • Primary Care Clinic/Center
  • Leesburg, FL
  • NPI 1659613776
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1568517522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 RAINBOW DR # 939",
            "city": "LIVINGSTON",
            "state": "TX",
            "postal_code": "773991009",
            "telephone_number": "352-410-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2474 PRINCETON DR",
            "city": "BARKSDALE AIR FORCE BASE",
            "state": "LA",
            "postal_code": "71111",
            "telephone_number": "352-410-5552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4602 Cr 673 # 939",
            "address_purpose": "LOCATION",
            "city": "Bushnell",
            "state": "FL",
            "postal_code": "335138358",
            "country_code": "US",
            "telephone_number": "352-410-5552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DWYER",
        "first_name": "MICHAEL",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "EDD, LCMHC, LCPS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "125924",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "11206",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NH",
            "license": "EL11259",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "8997",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ME",
            "license": "CC4401",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "MH8348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKE",
            "last_name": "DWYER",
            "middle_name": "V",
            "prefix": "DR.",
            "credential": "EDD, LPC-S, LCMHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jill Annette Cherry, D.D.S.

• Professional Counselor in Barksdale Air Force Base, LA
• Providers in Barksdale Air Force Base, LA by specialty
• Professional Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.