Provider Demographics
NPI:1881990489
Name:LANDENWITCH, MICHELLE M (LPCC, MED, EDS,)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:LANDENWITCH
Suffix:
Gender:F
Credentials:LPCC, MED, EDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12885 FROGTOWN CONNECTOR RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:KY
Mailing Address - Zip Code:41094-8391
Mailing Address - Country:US
Mailing Address - Phone:859-360-1044
Mailing Address - Fax:
Practice Address - Street 1:12885 FROGTOWN CONNECTOR RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:KY
Practice Address - Zip Code:41094-8391
Practice Address - Country:US
Practice Address - Phone:859-360-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1233101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor