Provider Demographics
NPI:1063104362
Name:DEUTSCH-MACKEY, MICHELLE (PLADC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DEUTSCH-MACKEY
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DEUTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLADC
Mailing Address - Street 1:1941 S 42ND ST STE 307
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2955
Mailing Address - Country:US
Mailing Address - Phone:402-979-8350
Mailing Address - Fax:888-490-0210
Practice Address - Street 1:1941 S 42ND ST STE 307
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2955
Practice Address - Country:US
Practice Address - Phone:402-979-8350
Practice Address - Fax:888-490-0210
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2069101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)