Provider Demographics
NPI:1497815062
Name:MAYGER-SKWIRUT, MICHELE L (PHD, LMFT, CADC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:MAYGER-SKWIRUT
Suffix:
Gender:F
Credentials:PHD, LMFT, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2818
Mailing Address - Country:US
Mailing Address - Phone:724-875-5485
Mailing Address - Fax:
Practice Address - Street 1:1225 S MAIN ST
Practice Address - Street 2:SUITE 203A
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5370
Practice Address - Country:US
Practice Address - Phone:724-875-5485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4435101YA0400X
PAMF000337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)