Provider Demographics
NPI:1720100613
Name:WORDEN, MICHELLE ANEIROS (NCC LPC 1027)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANEIROS
Last Name:WORDEN
Suffix:
Gender:F
Credentials:NCC LPC 1027
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070
Mailing Address - Country:US
Mailing Address - Phone:307-742-9390
Mailing Address - Fax:307-742-9717
Practice Address - Street 1:217 S 1ST STREET
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070
Practice Address - Country:US
Practice Address - Phone:307-742-9390
Practice Address - Fax:307-742-9717
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional