Provider Demographics
NPI:1396368684
Name:VANGELAS, MICHELE (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:VANGELAS
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:DUFUR
Mailing Address - State:OR
Mailing Address - Zip Code:97021-0172
Mailing Address - Country:US
Mailing Address - Phone:907-799-6476
Mailing Address - Fax:
Practice Address - Street 1:313 NE WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DUFUR
Practice Address - State:OR
Practice Address - Zip Code:97021
Practice Address - Country:US
Practice Address - Phone:907-799-6476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8381101Y00000X
AK202670101Y00000X
WALH61552694101Y00000X
IDLCPC-10369101Y00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor