Provider Demographics
NPI:1942749882
Name:SALEM, MICHELL (MA, LPC, NCC, CAADC)
Entity Type:Individual
Prefix:
First Name:MICHELL
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-2539
Mailing Address - Country:US
Mailing Address - Phone:517-244-0393
Mailing Address - Fax:
Practice Address - Street 1:706 CURTIS ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-2539
Practice Address - Country:US
Practice Address - Phone:517-244-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional