Provider Demographics
NPI:1023514692
Name:MICHELS, MELANIE ANINE (LLBSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANINE
Last Name:MICHELS
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANINE
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2715 S TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9294
Mailing Address - Country:US
Mailing Address - Phone:989-366-8550
Mailing Address - Fax:989-366-9420
Practice Address - Street 1:2715 S TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9294
Practice Address - Country:US
Practice Address - Phone:989-366-8550
Practice Address - Fax:989-366-9420
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802089877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker