Provider Demographics
NPI:1942570908
Name:TAKES, MICHELLE M (LMHC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:TAKES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 CENTER POINT RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5569
Mailing Address - Country:US
Mailing Address - Phone:319-200-4273
Mailing Address - Fax:
Practice Address - Street 1:3525 CENTER POINT RD NE STE C
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5569
Practice Address - Country:US
Practice Address - Phone:319-200-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health