Provider Demographics
NPI:1629120985
Name:CURTIS, MICHELLE RENE (MHC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:RENE
Other - Last Name:BLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC
Mailing Address - Street 1:122 N MARKET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2827
Mailing Address - Country:US
Mailing Address - Phone:641-295-2625
Mailing Address - Fax:
Practice Address - Street 1:122 N MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2827
Practice Address - Country:US
Practice Address - Phone:641-295-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00987101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health