Provider Demographics
NPI:1770932972
Name:PAUL, MICHELLE M (MED, LPCC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:PAUL
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 ST JOSEPH WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3764
Mailing Address - Country:US
Mailing Address - Phone:216-313-8929
Mailing Address - Fax:
Practice Address - Street 1:24500 CENTER RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5602
Practice Address - Country:US
Practice Address - Phone:440-455-1511
Practice Address - Fax:440-455-9500
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500254101YM0800X
OHE.1800970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health