Provider Demographics
NPI:1609107689
Name:BEHLOW, CHARLENE K (LMSW/MDIV)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:K
Last Name:BEHLOW
Suffix:
Gender:F
Credentials:LMSW/MDIV
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:K
Other - Last Name:JACKSON-MCMICHAEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW/MDIV
Mailing Address - Street 1:1417 MILLBROOK TRL
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-5916
Mailing Address - Country:US
Mailing Address - Phone:917-642-7963
Mailing Address - Fax:
Practice Address - Street 1:1417 MILLBROOK TRL
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-5916
Practice Address - Country:US
Practice Address - Phone:917-642-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0774991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical