Provider Demographics
NPI:1629397476
Name:MADLEY, MICHELE ANN (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANN
Last Name:MADLEY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:ANN
Other - Last Name:METZGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS LMHC
Mailing Address - Street 1:6401 S US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4749
Mailing Address - Country:US
Mailing Address - Phone:812-299-1156
Mailing Address - Fax:812-298-3291
Practice Address - Street 1:6401 S US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4749
Practice Address - Country:US
Practice Address - Phone:812-299-1156
Practice Address - Fax:812-298-3291
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001169A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health