Provider Demographics
NPI:1912408428
Name:LAND, MICHELLE NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:LAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 FM 1960 RD W STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4613
Mailing Address - Country:US
Mailing Address - Phone:281-302-4148
Mailing Address - Fax:281-302-4148
Practice Address - Street 1:4606 FM 1960 RD W STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4613
Practice Address - Country:US
Practice Address - Phone:281-302-4148
Practice Address - Fax:281-302-4148
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75191101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380633303Medicaid