Provider Demographics
NPI:1912977703
Name:HEINHOLD, MICHELLE GRAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GRAY
Last Name:HEINHOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9159 W FLAMINGO RD #106
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147
Mailing Address - Country:US
Mailing Address - Phone:702-496-1135
Mailing Address - Fax:888-780-3217
Practice Address - Street 1:9159 W FLAMINGO RD #106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147
Practice Address - Country:US
Practice Address - Phone:702-496-1135
Practice Address - Fax:888-780-3217
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2822-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical