Provider Demographics
NPI:1578926358
Name:MIRHOSEINI, MICHELLE DENISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DENISE
Last Name:MIRHOSEINI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 N CASS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2770
Mailing Address - Country:US
Mailing Address - Phone:414-291-9487
Mailing Address - Fax:414-291-9975
Practice Address - Street 1:1219 N CASS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2770
Practice Address - Country:US
Practice Address - Phone:414-291-9487
Practice Address - Fax:414-291-9975
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2914-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health