Provider Demographics
NPI:1033550710
Name:MICHAELSON, JOHN A (MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MICHAELSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 E BIRCH AVE
Mailing Address - Street 2:101
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2762
Mailing Address - Country:US
Mailing Address - Phone:509-684-3200
Mailing Address - Fax:509-684-1908
Practice Address - Street 1:358 E BIRCH AVE
Practice Address - Street 2:101
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2762
Practice Address - Country:US
Practice Address - Phone:509-684-3200
Practice Address - Fax:509-684-1908
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60252044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health