Provider Demographics
NPI:1922643535
Name:WESTERN, MICHELLE (LISW, LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WESTERN
Suffix:
Gender:F
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S, LICSW
Mailing Address - Street 1:805 CLARENCE DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-8446
Mailing Address - Country:US
Mailing Address - Phone:419-722-8083
Mailing Address - Fax:
Practice Address - Street 1:805 CLARENCE DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32404-8446
Practice Address - Country:US
Practice Address - Phone:419-722-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4338C1041C0700X
OHI.1800911-SUPV1041C0700X
FLSW195301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0383465Medicaid