Provider Demographics
NPI:1558398883
Name:VEST, MICHELLE MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MICHELLE
Last Name:VEST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:75 HWY 62/412
Practice Address - Street 2:SUITE J
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9629
Practice Address - Country:US
Practice Address - Phone:870-944-7060
Practice Address - Fax:870-994-7063
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ARP9903007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U299OtherBCBS
AR172526795Medicaid
AR5U299OtherBLUECROSS PROVIDER NUMBER