Provider Demographics
NPI:1427057579
Name:POLSON, MICHOL (LMFT)
Entity type:Individual
Prefix:DR
First Name:MICHOL
Middle Name:
Last Name:POLSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MAIN ST, SUITE 207
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-223-9417
Mailing Address - Fax:541-882-2583
Practice Address - Street 1:501 MAIN ST, SUITE 207
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-223-9417
Practice Address - Fax:541-882-2583
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000940106H00000X
TN845106H00000X
ORT0815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500649144Medicaid