Provider Demographics
NPI:1861851495
Name:CRIDDLE, MICHELE LYNETTE (LMFT-A, MA LCDC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNETTE
Last Name:CRIDDLE
Suffix:
Gender:F
Credentials:LMFT-A, MA LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 MILLER WILSON RD
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-5820
Mailing Address - Country:US
Mailing Address - Phone:832-584-3565
Mailing Address - Fax:
Practice Address - Street 1:6014 MILLER WILSON RD
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-5820
Practice Address - Country:US
Practice Address - Phone:832-584-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12985101YA0400X
TX202696106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)