Provider Demographics
NPI:1962936971
Name:MICHELS, MARIE (MSW,LCSW)
Entity type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:
Last Name:MICHELS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9277 COVENANT RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-8015
Mailing Address - Country:US
Mailing Address - Phone:406-544-0599
Mailing Address - Fax:
Practice Address - Street 1:411 B STREET
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:MT
Practice Address - Zip Code:59808
Practice Address - Country:US
Practice Address - Phone:406-246-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-236961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical