Provider Demographics
NPI:1467139840
Name:ANDERSON, MICHELLE LYNN (MS LADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 8TH ST S STE 3
Mailing Address - Street 2:1401 8TH STREET SOUTH SUITE 3
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3658
Mailing Address - Country:US
Mailing Address - Phone:218-284-1800
Mailing Address - Fax:218-600-5484
Practice Address - Street 1:1401 8TH ST S STE 3
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3658
Practice Address - Country:US
Practice Address - Phone:218-284-1800
Practice Address - Fax:218-600-5484
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306573101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional