Provider Demographics
NPI:1164770244
Name:KLEIN, MICHELLE MARIE (MED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 HOMESTEAD LN
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1525
Mailing Address - Country:US
Mailing Address - Phone:814-441-1122
Mailing Address - Fax:
Practice Address - Street 1:3943 S ATHERTON ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-8308
Practice Address - Country:US
Practice Address - Phone:814-466-9322
Practice Address - Fax:814-466-9323
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC006608OtherSTATE LICENSE