Provider Demographics
NPI:1053466888
Name:SAMES, MICHELLE D (LPCC-S)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:SAMES
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1912
Mailing Address - Country:US
Mailing Address - Phone:859-385-4669
Mailing Address - Fax:859-201-1450
Practice Address - Street 1:104 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1912
Practice Address - Country:US
Practice Address - Phone:859-385-4669
Practice Address - Fax:859-201-1450
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1025101YP2500X
KY103853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100296710Medicaid
KY3316Medicare ID - Type UnspecifiedMEDICARE