Provider Demographics
NPI:1114223534
Name:WALBLAY, MICHELLE RENE (MED)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENE
Last Name:WALBLAY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 E EASTRIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8562
Mailing Address - Country:US
Mailing Address - Phone:928-777-3260
Mailing Address - Fax:
Practice Address - Street 1:8603 E EASTRIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8562
Practice Address - Country:US
Practice Address - Phone:928-777-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor