Provider Demographics
NPI:1891010302
Name:NIELSON, MICHELE (M ED)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:NIELSON
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CALISTOGA ST. W.
Mailing Address - Street 2:PO BOX 1574
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-1574
Mailing Address - Country:US
Mailing Address - Phone:253-576-7957
Mailing Address - Fax:
Practice Address - Street 1:106 CALISTOGA ST. W. UNIT B
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-1574
Practice Address - Country:US
Practice Address - Phone:253-576-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00030055101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor