Provider Demographics
NPI:1114273703
Name:MICHAELS, SCOTT R (LMFT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 EXACTA LN APT 516
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8968
Mailing Address - Country:US
Mailing Address - Phone:919-576-0350
Mailing Address - Fax:
Practice Address - Street 1:3170 EXACTA LN APT 516
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613
Practice Address - Country:US
Practice Address - Phone:919-576-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist