Provider Demographics
NPI:1407670193
Name:FRITZ, MICHELE RENEE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:FRITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:FRITZ
Other - Last Name:FRITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WY
Mailing Address - Zip Code:82836-1087
Mailing Address - Country:US
Mailing Address - Phone:307-763-7422
Mailing Address - Fax:
Practice Address - Street 1:903 BECKTON ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WY
Practice Address - Zip Code:82836-5009
Practice Address - Country:US
Practice Address - Phone:307-763-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-1580101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty