Provider Demographics
NPI:1649442062
Name:CLARKSON, MICHELE (MSW,LCSW,CDST,CS)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:MSW,LCSW,CDST,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3807
Mailing Address - Country:US
Mailing Address - Phone:480-600-1518
Mailing Address - Fax:480-816-6619
Practice Address - Street 1:7101 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3807
Practice Address - Country:US
Practice Address - Phone:480-600-1518
Practice Address - Fax:480-816-6619
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00004059OtherSTATE BUSINESS LICENSE