Provider Demographics
NPI:1023367018
Name:CUSHMAN, MICHELLE LEIGH (PHD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEIGH
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEIGH
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:202 SW CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-3008
Mailing Address - Country:US
Mailing Address - Phone:515-325-4133
Mailing Address - Fax:844-799-6001
Practice Address - Street 1:202 SW CHERRY ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-3008
Practice Address - Country:US
Practice Address - Phone:515-325-4133
Practice Address - Fax:844-799-6001
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001360103TC1900X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling