Provider Demographics
NPI:1609386929
Name:VINCI, MICHELLE D (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:VINCI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 SE MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2825
Mailing Address - Country:US
Mailing Address - Phone:971-285-6545
Mailing Address - Fax:971-266-4901
Practice Address - Street 1:2104 SE MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2825
Practice Address - Country:US
Practice Address - Phone:971-285-6545
Practice Address - Fax:971-266-4901
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1472106H00000X
CT1846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist