Provider Demographics
NPI:1598815342
Name:CROCE, MICHELLE LYNN (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:CROCE
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-0466
Mailing Address - Country:US
Mailing Address - Phone:517-279-8866
Mailing Address - Fax:517-279-8866
Practice Address - Street 1:694 W CHICAGO RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8405
Practice Address - Country:US
Practice Address - Phone:517-279-8866
Practice Address - Fax:517-279-8866
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015633103TC0700X
MI6301010654103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6130461OtherPHP
MIP108953080OtherBCBS
MI6130461OtherPHP