Provider Demographics
NPI:1629433685
Name:CHAMPION, MICHELLE DENISE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8696 SUNSET HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-3457
Mailing Address - Country:US
Mailing Address - Phone:281-414-3830
Mailing Address - Fax:936-703-3990
Practice Address - Street 1:41206 N MILL DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1874
Practice Address - Country:US
Practice Address - Phone:936-273-3226
Practice Address - Fax:936-273-3226
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child