Provider Demographics
NPI:1083678684
Name:BABB, MICHELE M (PHD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:BABB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 WOODLAND DRIVE
Mailing Address - Street 2:#200 CLINICAL PSYCHOLOGIST
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537
Mailing Address - Country:US
Mailing Address - Phone:419-897-7950
Mailing Address - Fax:419-897-7984
Practice Address - Street 1:1690 WOODLAND DRIVE
Practice Address - Street 2:#200 CLINICAL PSYCHOLOGIST
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537
Practice Address - Country:US
Practice Address - Phone:419-897-7950
Practice Address - Fax:419-897-7984
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP6052103T00000X
MNLP0932103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000389994OtherANTHEM
OH06732OtherPARAMOUNT
OH06732OtherPARAMOUNT
BACP31301Medicare UPIN
BACP31302Medicare PIN