Provider Demographics
NPI:1710551932
Name:GAINES, MICHELE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N EL CAMINO DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1424
Mailing Address - Country:US
Mailing Address - Phone:734-787-5438
Mailing Address - Fax:
Practice Address - Street 1:1425 N EL CAMINO DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1424
Practice Address - Country:US
Practice Address - Phone:734-787-5438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013592101YM0800X
AZ17576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health