Provider Demographics
NPI:1477268985
Name:CEARLEY, MICHELLE LEE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:CEARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYTCH
Other - Middle Name:
Other - Last Name:CEARLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4856 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5540
Mailing Address - Country:US
Mailing Address - Phone:970-494-4200
Mailing Address - Fax:970-613-4475
Practice Address - Street 1:114 BRISTLECONE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2031
Practice Address - Country:US
Practice Address - Phone:970-494-4200
Practice Address - Fax:970-484-9380
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist