Provider Demographics
NPI:1699055681
Name:SUNDQUIST, MICHELLE COLLEEN (LCPC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:COLLEEN
Last Name:SUNDQUIST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10373 LONELEAF DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7936
Mailing Address - Country:US
Mailing Address - Phone:208-649-8994
Mailing Address - Fax:
Practice Address - Street 1:10373 LONELEAF DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7936
Practice Address - Country:US
Practice Address - Phone:208-649-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC5303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health