Provider Demographics
NPI:1770360687
Name:THORSTEINSON, MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:THORSTEINSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 AVENUE D STE 226
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1742
Mailing Address - Country:US
Mailing Address - Phone:206-915-7461
Mailing Address - Fax:
Practice Address - Street 1:909 W MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2031
Practice Address - Country:US
Practice Address - Phone:206-915-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61440145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health