Provider Demographics
NPI:1700178431
Name:WINEMILLER, MICHELLE MARIE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:WINEMILLER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:WINEMILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC
Mailing Address - Street 1:1160 LAPORTE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2422
Mailing Address - Country:US
Mailing Address - Phone:507-269-9391
Mailing Address - Fax:
Practice Address - Street 1:1160 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2422
Practice Address - Country:US
Practice Address - Phone:507-244-0222
Practice Address - Fax:970-821-8466
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MN2558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2558OtherMINNESOTA BOARD OF MARRIAGE AND FAMILY THERAPY LICENSE
COMFT.0001565OtherCOLORADO DEPT OF REGULATORY AGENCIES - MFT LICENSE