Provider Demographics
NPI:1154852721
Name:CAULK, MICHELLE (PHD, LMHC, LPC,)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CAULK
Suffix:
Gender:F
Credentials:PHD, LMHC, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FAIRLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-7104
Mailing Address - Country:US
Mailing Address - Phone:813-391-6124
Mailing Address - Fax:
Practice Address - Street 1:17315 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63038-1902
Practice Address - Country:US
Practice Address - Phone:636-735-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019009805101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health