Provider Demographics
NPI:1194880799
Name:KAHN, MICHELE LOIS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LOIS
Last Name:KAHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W THUNDERBIRD RD STE 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4722
Mailing Address - Country:US
Mailing Address - Phone:602-938-3323
Mailing Address - Fax:602-938-1626
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4722
Practice Address - Country:US
Practice Address - Phone:602-938-3323
Practice Address - Fax:602-938-1626
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-108211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical