Provider Demographics
NPI:1376085944
Name:MICHELLE EDENFIELD COUNSELING
Entity Type:Organization
Organization Name:MICHELLE EDENFIELD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:EDENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:330-597-3335
Mailing Address - Street 1:6715 TIPPECANOE RD
Mailing Address - Street 2:BLDG E SUITE L01
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8180
Mailing Address - Country:US
Mailing Address - Phone:330-301-3762
Mailing Address - Fax:
Practice Address - Street 1:6715 TIPPECANOE RD
Practice Address - Street 2:BLDG E SUITE L01
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8180
Practice Address - Country:US
Practice Address - Phone:330-301-3762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-13
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0700204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty