Provider Demographics
NPI:1518400944
Name:MICHIELS, DAVID (LCPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MICHIELS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 E WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2333
Mailing Address - Country:US
Mailing Address - Phone:312-788-4491
Mailing Address - Fax:
Practice Address - Street 1:154 E WINDSOR AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2333
Practice Address - Country:US
Practice Address - Phone:312-788-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010103101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional