Provider Demographics
NPI:1689264178
Name:NOFFZE, MICHELLE MARIE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:NOFFZE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 HOLLINGER ST
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1300
Mailing Address - Country:US
Mailing Address - Phone:218-252-2785
Mailing Address - Fax:218-732-4695
Practice Address - Street 1:1009 HOLLINGER ST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1300
Practice Address - Country:US
Practice Address - Phone:218-252-2785
Practice Address - Fax:218-732-4695
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02591101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1689264178Medicaid