Provider Demographics
NPI:1184195588
Name:WINTER, MICHAEL (MA, LPCC-S)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WINTER
Suffix:
Gender:M
Credentials:MA, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1429
Mailing Address - Country:US
Mailing Address - Phone:952-200-7093
Mailing Address - Fax:
Practice Address - Street 1:586 WESTWOOD LN
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1429
Practice Address - Country:US
Practice Address - Phone:952-200-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional