Provider Demographics
NPI:1700924305
Name:RIES, MICHELE ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ELAINE
Last Name:RIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 POWELL CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-6821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3733
Practice Address - Country:US
Practice Address - Phone:931-424-7199
Practice Address - Fax:931-424-7199
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000045761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441175Medicaid