Provider Demographics
NPI:1376073452
Name:SLABAUGH, MICHELE (DBH, LPC/MHSP, NCC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:SLABAUGH
Suffix:
Gender:F
Credentials:DBH, LPC/MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049-5114
Mailing Address - Country:US
Mailing Address - Phone:215-804-8306
Mailing Address - Fax:
Practice Address - Street 1:8919 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37049-5114
Practice Address - Country:US
Practice Address - Phone:215-804-8306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009653101YP2500X
TN5738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional