Provider Demographics
NPI:1326425869
Name:UPDEGRAFF, MICHELLE (LPC-CR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:UPDEGRAFF
Suffix:
Gender:F
Credentials:LPC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MULBERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3307
Mailing Address - Country:US
Mailing Address - Phone:740-393-6001
Mailing Address - Fax:
Practice Address - Street 1:111 S MULBERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3307
Practice Address - Country:US
Practice Address - Phone:740-393-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 1300554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
13551221OtherCAQH