Provider Demographics
NPI:1497755409
Name:CRAVEIRO, MICHELLE ANN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:CRAVEIRO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HWY 100 SOUTH
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-224-0399
Mailing Address - Fax:612-374-4498
Practice Address - Street 1:1684 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:952-222-0399
Practice Address - Fax:612-374-4498
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1023106H00000X
MNLMFT1023106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist