Provider Demographics
NPI:1639258874
Name:FORAKER, MICHELLE RENEE (MAED, LPCC-S)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE
Last Name:FORAKER
Suffix:
Gender:F
Credentials:MAED, LPCC-S
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:COWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAED, LPCC-S
Mailing Address - Street 1:1201 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4283
Mailing Address - Country:US
Mailing Address - Phone:330-244-8782
Mailing Address - Fax:330-244-8795
Practice Address - Street 1:1201 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4283
Practice Address - Country:US
Practice Address - Phone:330-244-8782
Practice Address - Fax:330-244-8795
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500227101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor