Provider Demographics
NPI:1578623419
Name:MICHAELS-STICKLE, MARY JANE (EDD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JANE
Last Name:MICHAELS-STICKLE
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2812
Mailing Address - Country:US
Mailing Address - Phone:570-748-7173
Mailing Address - Fax:570-748-5717
Practice Address - Street 1:120 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2812
Practice Address - Country:US
Practice Address - Phone:570-748-7173
Practice Address - Fax:570-748-5717
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional