Provider Demographics
NPI:1740862853
Name:TREMBLAY, MICHELLE K (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:K
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3395 THOMSEN RD
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-8404
Mailing Address - Country:US
Mailing Address - Phone:541-806-0901
Mailing Address - Fax:
Practice Address - Street 1:3395 THOMSEN RD
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-8404
Practice Address - Country:US
Practice Address - Phone:541-806-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60154011101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACL60154011OtherWASHINGTON STATE COUNSELING