Provider Demographics
NPI:1134131048
Name:WOLFE, MICHAEL J (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WOLFE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-1617
Mailing Address - Country:US
Mailing Address - Phone:208-293-5673
Mailing Address - Fax:
Practice Address - Street 1:110 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7701
Practice Address - Country:US
Practice Address - Phone:907-283-6693
Practice Address - Fax:907-283-7088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-269441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID200014396OtherCORP CARE EAP
200014396OtherIDAHO PHYSICIAN NETWORK
200014396OtherMHNNET
ID200014396OtherPPO NEXT
ID200014396OtherMULTIPLAN NETWORK
ID200014396OtherFIRST CHOICE HEALTH FCHN (PPO NETWORK)
ID7266724OtherAETNA
ID262226OtherCOMP PSYCH
IDL5774OtherBLUE CROSS OF IDAHO
ID0000101 53279OtherREGENCE BLUE SHIELD
ID2212157OtherCIGNA BEHAVIORAL HEALTH
200014396OtherIDAHO PHYSICIAN NETWORK