Provider Demographics
NPI:1770154379
Name:YANG, MICHELLE ALEXANDRIA GOWAN (LPC INTERN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ALEXANDRIA GOWAN
Last Name:YANG
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SABRA LN NE APT 303
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2312
Mailing Address - Country:US
Mailing Address - Phone:775-934-3093
Mailing Address - Fax:
Practice Address - Street 1:5119 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5349
Practice Address - Country:US
Practice Address - Phone:503-362-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional