Provider Demographics
NPI:1568646990
Name:MICHELS, CHRISTINE JOY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:JOY
Last Name:MICHELS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 BALLYSHANNON DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4113
Mailing Address - Country:US
Mailing Address - Phone:390-212-2442
Mailing Address - Fax:309-664-7962
Practice Address - Street 1:1303 BALLYSHANNON DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4113
Practice Address - Country:US
Practice Address - Phone:390-664-7962
Practice Address - Fax:309-664-7962
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0114711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical