Provider Demographics
NPI:1407509086
Name:PATINELLA, MICHELLE (MA, ACMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PATINELLA
Suffix:
Gender:F
Credentials:MA, ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 W 200 S
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737
Mailing Address - Country:US
Mailing Address - Phone:847-651-2838
Mailing Address - Fax:
Practice Address - Street 1:321 N MALL DR STE B201
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7310
Practice Address - Country:US
Practice Address - Phone:435-229-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12359572-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health