Provider Demographics
NPI:1013723899
Name:MISHRA, MICHELE ELIZABETH (LICSWA)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:MISHRA
Suffix:
Gender:F
Credentials:LICSWA
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:ELIZABETH
Other - Last Name:HOWARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:769 HAYES ST APT 309
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7902 168TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4445
Practice Address - Country:US
Practice Address - Phone:425-472-2681
Practice Address - Fax:425-968-5619
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61532519104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker