Provider Demographics
NPI:1578974978
Name:SPELL, MICHAEL (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SPELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHESTNUT ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-1453
Mailing Address - Country:US
Mailing Address - Phone:325-280-7131
Mailing Address - Fax:
Practice Address - Street 1:500 CHESTNUT ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1453
Practice Address - Country:US
Practice Address - Phone:325-280-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist