Provider Demographics
NPI:1104015197
Name:ABELLA, MICHELLE (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ABELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17795 W 106TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3155
Mailing Address - Country:US
Mailing Address - Phone:913-296-0712
Mailing Address - Fax:913-273-0801
Practice Address - Street 1:17795 W 106TH ST STE 202
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3155
Practice Address - Country:US
Practice Address - Phone:913-296-0712
Practice Address - Fax:913-273-0801
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007363103TC2200X
KS1673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent