Provider Demographics
NPI:1881187482
Name:HARRELL, MICHELLE RENEE (EDS, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:EDS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23380 N 61ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5748
Mailing Address - Country:US
Mailing Address - Phone:602-358-7073
Mailing Address - Fax:888-927-0409
Practice Address - Street 1:203 S CANDY LN STE 6AB
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:602-358-7073
Practice Address - Fax:888-927-0409
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-20437OtherAZ- LPC LICENSE