Provider Demographics
NPI:1013112861
Name:FARIAS, MICHELLE MEYER (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MEYER
Last Name:FARIAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JEAN
Other - Last Name:FARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2711 GAINESBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4528
Mailing Address - Country:US
Mailing Address - Phone:210-725-5379
Mailing Address - Fax:
Practice Address - Street 1:2711 GAINESBOROUGH DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4528
Practice Address - Country:US
Practice Address - Phone:210-725-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional