Provider Demographics
NPI:1841586344
Name:WOLF, MICHELLE LORRAINE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LORRAINE
Last Name:WOLF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LORRAINE
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:800 ROCKMEAD DR STE 155
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2652
Mailing Address - Country:US
Mailing Address - Phone:281-900-8960
Mailing Address - Fax:281-677-4199
Practice Address - Street 1:800 ROCKMEAD DR STE 155
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2652
Practice Address - Country:US
Practice Address - Phone:281-900-8960
Practice Address - Fax:281-677-4199
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18743OtherTEXAS STATE BOARD