Provider Demographics
NPI:1750502332
Name:WEBSTER, MICHELLE RAE (MS, CAC III)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RAE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MS, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 E 103RD DR. # 712
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229
Mailing Address - Country:US
Mailing Address - Phone:303-920-5721
Mailing Address - Fax:303-487-7240
Practice Address - Street 1:8989 HURON ST.
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260
Practice Address - Country:US
Practice Address - Phone:303-853-3568
Practice Address - Fax:303-487-7240
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health