Provider Demographics
NPI:1801920491
Name:MICHAELS, MALLEREY L (MSW, LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:MALLEREY
Middle Name:L
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MSW, LMSW, ACSW
Other - Prefix:MS
Other - First Name:JULIANNE
Other - Middle Name:L
Other - Last Name:FAIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LMSW, ACSW, LPN
Mailing Address - Street 1:3815 GETTYSBURG ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-5804
Mailing Address - Country:US
Mailing Address - Phone:989-837-3861
Mailing Address - Fax:
Practice Address - Street 1:1321 S FAYETTE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1447
Practice Address - Country:US
Practice Address - Phone:989-792-8000
Practice Address - Fax:989-792-8445
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801046535104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker