Provider Demographics
NPI:1568842805
Name:MICHAEL, MAUREEN (MS LPC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 S GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4241
Mailing Address - Country:US
Mailing Address - Phone:928-863-8703
Mailing Address - Fax:928-515-2416
Practice Address - Street 1:711 S GRANITE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4241
Practice Address - Country:US
Practice Address - Phone:928-493-4373
Practice Address - Fax:928-515-2416
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLSAT 15116101YA0400X
AZLPC-19892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)