Provider Demographics
NPI:1821510462
Name:BROWNLEE, MICHELLE (PEER RECOVERY COACH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BROWNLEE
Suffix:
Gender:F
Credentials:PEER RECOVERY COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WOODLAND SQUARE LOOP SE STE 401
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1070
Mailing Address - Country:US
Mailing Address - Phone:360-701-8580
Mailing Address - Fax:360-489-1435
Practice Address - Street 1:2000 LAKERIDGE DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6001
Practice Address - Country:US
Practice Address - Phone:360-701-8580
Practice Address - Fax:360-489-1435
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1821510462Medicaid