Provider Demographics
NPI:1255057907
Name:PIERCE, MICHELLE CAROLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CAROLE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:INGALLS
Mailing Address - State:IN
Mailing Address - Zip Code:46048-9500
Mailing Address - Country:US
Mailing Address - Phone:765-621-6670
Mailing Address - Fax:
Practice Address - Street 1:401 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:INGALLS
Practice Address - State:IN
Practice Address - Zip Code:46048-9500
Practice Address - Country:US
Practice Address - Phone:765-621-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst