Provider Demographics
NPI:1811425176
Name:MARLER, MICHELLE RENAE (MS/LMHC/CMHS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENAE
Last Name:MARLER
Suffix:
Gender:F
Credentials:MS/LMHC/CMHS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MARTIN-GOLLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:707 W 7TH AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2821
Mailing Address - Country:US
Mailing Address - Phone:509-655-4511
Mailing Address - Fax:509-484-6191
Practice Address - Street 1:707 W 7TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2821
Practice Address - Country:US
Practice Address - Phone:509-655-4511
Practice Address - Fax:509-484-6191
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60746121101YS0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1811425176Medicaid