Provider Demographics
NPI:1184084188
Name:CARTHARIUS, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CARTHARIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:FRIZZELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC II, CRM
Mailing Address - Street 1:301 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3459
Mailing Address - Country:US
Mailing Address - Phone:541-910-5577
Mailing Address - Fax:
Practice Address - Street 1:1101 I AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2043
Practice Address - Country:US
Practice Address - Phone:541-805-2626
Practice Address - Fax:541-605-6005
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17-CRM-209175T00000X, 175T00000X
OR18-04-14101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)