Provider Demographics
NPI:1821553025
Name:PELLE, MICHELLE (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PELLE
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S ABILENE ST
Mailing Address - Street 2:PO BOX 440163
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014
Mailing Address - Country:US
Mailing Address - Phone:303-335-9892
Mailing Address - Fax:
Practice Address - Street 1:1738 WYNKOOP ST STE 303
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1000
Practice Address - Country:US
Practice Address - Phone:303-335-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001804101YA0400X
COCSW.099270961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)