Provider Demographics
NPI:1699829739
Name:APPLE, MICHELLE VEGA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:VEGA
Last Name:APPLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:16980 DALLAS PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1910
Mailing Address - Country:US
Mailing Address - Phone:972-767-9194
Mailing Address - Fax:
Practice Address - Street 1:16980 DALLAS PKWY STE 204
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1910
Practice Address - Country:US
Practice Address - Phone:972-767-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX19034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S49VOtherBLUE CROSS BLUE SHEILD
TX225427367OtherUNITED BEHAVIORAL HEALTH
93-4674657OtherSTATE
TX225427367OtherUNITED BEHAVIORAL HEALTH