Provider Demographics
NPI:1669870812
Name:MICHAELS, MELODEE ANN
Entity type:Individual
Prefix:
First Name:MELODEE
Middle Name:ANN
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELODEE
Other - Middle Name:ANN
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:189 TOWNSEND ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6008
Mailing Address - Country:US
Mailing Address - Phone:248-540-0555
Mailing Address - Fax:248-540-2180
Practice Address - Street 1:189 TOWNSEND ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6008
Practice Address - Country:US
Practice Address - Phone:248-540-0555
Practice Address - Fax:248-540-2180
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010129951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical