Provider Demographics
NPI:1922420405
Name:ELIAS, MICHELLE (LPC , CACIII)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:LPC , CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO. BOX 1208
Mailing Address - Street 2:MIDWESTERN CO.MENTAL HEALTH
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402-2244
Mailing Address - Country:US
Mailing Address - Phone:970-624-4606
Mailing Address - Fax:
Practice Address - Street 1:710 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2244
Practice Address - Country:US
Practice Address - Phone:970-624-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7026101YA0400X
CO11248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)