Provider Demographics
NPI:1548868664
Name:VILLARREAL, MICHELLE (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7331
Mailing Address - Country:US
Mailing Address - Phone:254-493-9071
Mailing Address - Fax:
Practice Address - Street 1:4720 BOX CANYON DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7311
Practice Address - Country:US
Practice Address - Phone:254-493-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75996101YP2500X
TX14561101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)