Provider Demographics
NPI:1205026945
Name:MICHEL, JON C (LMHC LADC-1)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:MICHEL
Suffix:
Gender:M
Credentials:LMHC LADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TOTMAN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7564
Mailing Address - Country:US
Mailing Address - Phone:978-502-4404
Mailing Address - Fax:617-471-6327
Practice Address - Street 1:21 TOTMAN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:978-502-4404
Practice Address - Fax:617-471-6327
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health