Provider Demographics
NPI:1124495254
Name:MATTINGLY, MICHELLE EILEEN
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:EILEEN
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 REPUBLIC ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-7016
Mailing Address - Country:US
Mailing Address - Phone:513-313-1608
Mailing Address - Fax:
Practice Address - Street 1:1526 REPUBLIC ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-7016
Practice Address - Country:US
Practice Address - Phone:513-242-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor