Provider Demographics
NPI:1184859704
Name:ANTHONY, MICHELE VALENTON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:VALENTON
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 RANFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1473
Mailing Address - Country:US
Mailing Address - Phone:317-288-4860
Mailing Address - Fax:
Practice Address - Street 1:10215 RANFORD BLVD
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1473
Practice Address - Country:US
Practice Address - Phone:317-288-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010841711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical