Provider Demographics
NPI:1518153766
Name:MIQUEL, RAQUEL SARA (LLP)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:SARA
Last Name:MIQUEL
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4319
Mailing Address - Country:US
Mailing Address - Phone:989-753-8446
Mailing Address - Fax:989-753-8446
Practice Address - Street 1:710 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4319
Practice Address - Country:US
Practice Address - Phone:989-753-8446
Practice Address - Fax:989-753-8446
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301000888101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health