Provider Demographics
NPI:1184903668
Name:KLOTZ, MICHELLE MARION (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARION
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1809
Mailing Address - Country:US
Mailing Address - Phone:508-835-3695
Mailing Address - Fax:
Practice Address - Street 1:9 MAPLE ST STE 3
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1838
Practice Address - Country:US
Practice Address - Phone:774-261-0289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health