Provider Demographics
NPI:1245991892
Name:GRANDEN, MICHELLE (PHD, LMHCA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GRANDEN
Suffix:
Gender:F
Credentials:PHD, LMHCA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 NW DOGWOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3258
Mailing Address - Country:US
Mailing Address - Phone:425-269-3277
Mailing Address - Fax:
Practice Address - Street 1:75 NW DOGWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3258
Practice Address - Country:US
Practice Address - Phone:425-269-3277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61193958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health