Provider Demographics
NPI:1295934370
Name:STAHLEY, MICHELLE (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:STAHLEY
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WILLIAM ST UNIT 6234
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-0157
Mailing Address - Country:US
Mailing Address - Phone:773-234-9802
Mailing Address - Fax:650-489-3226
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:773-234-9802
Practice Address - Fax:650-489-3226
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2023-03-30
Deactivation Date:2007-07-24
Deactivation Code:
Reactivation Date:2007-08-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health