Provider Demographics
NPI:1891940870
Name:MCHENRY, MICHELLE PATRICIA (LPC W/ SA SPEC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PATRICIA
Last Name:MCHENRY
Suffix:
Gender:F
Credentials:LPC W/ SA SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 3RD ST N STE 205
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3288
Mailing Address - Country:US
Mailing Address - Phone:608-782-1400
Mailing Address - Fax:608-782-1002
Practice Address - Street 1:700 3RD ST N
Practice Address - Street 2:SUITE 205
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-9303
Practice Address - Country:US
Practice Address - Phone:608-782-1400
Practice Address - Fax:608-782-1002
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5512-125101YA0400X, 101YP2500X
WI9720-1201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100044381Medicaid