Provider Demographics
NPI:1861022642
Name:LALICATA, MICHELE (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LALICATA
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 E FANDANGO DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-8769
Mailing Address - Country:US
Mailing Address - Phone:480-821-4898
Mailing Address - Fax:
Practice Address - Street 1:2899 E FANDANGO DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-8769
Practice Address - Country:US
Practice Address - Phone:480-821-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist