Provider Demographics
NPI:1316595051
Name:ROSENTHAL, MICHELLE R (LPC, LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3682 CHASE CT
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5531
Mailing Address - Country:US
Mailing Address - Phone:914-260-9254
Mailing Address - Fax:
Practice Address - Street 1:3682 CHASE CT
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5531
Practice Address - Country:US
Practice Address - Phone:914-260-9254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0002238101YA0400X
COMT.0020571225700000X
COLPC.0019153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist