Provider Demographics
NPI:1699849281
Name:MISSEL, MICHELLE JENKINS (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JENKINS
Last Name:MISSEL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 BONHAM CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5502
Mailing Address - Country:US
Mailing Address - Phone:864-214-6402
Mailing Address - Fax:864-328-3210
Practice Address - Street 1:714 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5514
Practice Address - Country:US
Practice Address - Phone:864-214-6402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional