Provider Demographics
NPI:1528493038
Name:HUNT, MICHELLE M (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:HUNT
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 1:749 WHITTIER ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-2724
Mailing Address - Country:US
Mailing Address - Phone:208-709-3019
Mailing Address - Fax:
Practice Address - Street 1:2275 WEST BROADWAY
Practice Address - Street 2:SUITE G
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-2902
Practice Address - Country:US
Practice Address - Phone:208-524-7400
Practice Address - Fax:208-524-8004
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-281501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical