Provider Demographics
NPI:1174933410
Name:COSTIGAN, MICHELLE (CPC, LCADC, ATR)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COSTIGAN
Suffix:
Gender:F
Credentials:CPC, LCADC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 N GREEN VALLEY PKWY STE 503
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2764 N GREEN VALLEY PKWY STE 503
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2120
Practice Address - Country:US
Practice Address - Phone:224-730-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00423-LC101YA0400X
IL180.010324101YM0800X
NVCP0165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)