Provider Demographics
NPI:1083328389
Name:ASBURRY, MICHAELA (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:ASBURRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 TANGLEY RD APT 1
Mailing Address - Street 2:
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58704-1702
Mailing Address - Country:US
Mailing Address - Phone:503-806-7450
Mailing Address - Fax:
Practice Address - Street 1:2400 BURDICK EXPY E STE 101
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5006
Practice Address - Country:US
Practice Address - Phone:701-335-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health