Provider Demographics
NPI:1952962540
Name:HARKEY, MICHELLE (LPCC, LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARKEY
Suffix:
Gender:F
Credentials:LPCC, LMT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:WILDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC, LMT
Mailing Address - Street 1:3250 TRINITY DR STE B2
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3250 TRINITY DR STE B2
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2226
Practice Address - Country:US
Practice Address - Phone:505-695-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0204521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty