Provider Demographics
NPI:1023568698
Name:MUNCY, MICHELLE FAITH (LMFT, CBIS, TCADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FAITH
Last Name:MUNCY
Suffix:
Gender:F
Credentials:LMFT, CBIS, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 HEMINGWAY PL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-2318
Mailing Address - Country:US
Mailing Address - Phone:769-355-9039
Mailing Address - Fax:
Practice Address - Street 1:168 HEMINGWAY PL
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-2318
Practice Address - Country:US
Practice Address - Phone:769-355-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171363101YA0400X
KY245599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)