Provider Demographics
NPI:1659023687
Name:TIGUE, MICHELLE (PHD-ABD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TIGUE
Suffix:
Gender:F
Credentials:PHD-ABD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 MOUNTAIN VISTA LN
Mailing Address - Street 2:
Mailing Address - City:FILER
Mailing Address - State:ID
Mailing Address - Zip Code:83328-5555
Mailing Address - Country:US
Mailing Address - Phone:208-404-6049
Mailing Address - Fax:
Practice Address - Street 1:4030 MOUNTAIN VISTA LN
Practice Address - Street 2:
Practice Address - City:FILER
Practice Address - State:ID
Practice Address - Zip Code:83328-5555
Practice Address - Country:US
Practice Address - Phone:208-404-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth