Provider Demographics
NPI:1063953446
Name:WOODWARD, MICHELLE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13178 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-7320
Mailing Address - Country:US
Mailing Address - Phone:208-304-8811
Mailing Address - Fax:
Practice Address - Street 1:1717 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-9329
Practice Address - Country:US
Practice Address - Phone:208-265-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional