Provider Demographics
NPI:1720652431
Name:WITHAM, MICHAEL D (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:WITHAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1916
Mailing Address - Country:US
Mailing Address - Phone:605-212-6902
Mailing Address - Fax:
Practice Address - Street 1:206 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1916
Practice Address - Country:US
Practice Address - Phone:605-212-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health