Provider Demographics
NPI:1790961464
Name:CLEM, MICHELLE B (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:B
Last Name:CLEM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JACOB
Other - Last Name:BURCHFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:201 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38756-3401
Mailing Address - Country:US
Mailing Address - Phone:662-686-4121
Mailing Address - Fax:662-686-4770
Practice Address - Street 1:201 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:MS
Practice Address - Zip Code:38756
Practice Address - Country:US
Practice Address - Phone:662-686-4121
Practice Address - Fax:662-686-4770
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health