Provider Demographics
NPI:1689913717
Name:DK MICHELLE
Entity Type:Organization
Organization Name:DK MICHELLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:330-801-4251
Mailing Address - Street 1:795 SHARON DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:795 SHARON DR
Practice Address - Street 2:SUITE 208
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1542
Practice Address - Country:US
Practice Address - Phone:330-801-4251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty