Provider Demographics
NPI:1982811501
Name:MARSHALL, MICHELLE DENISE (LPC)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:DENISE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 BLANDING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-3410
Mailing Address - Country:US
Mailing Address - Phone:314-761-9288
Mailing Address - Fax:
Practice Address - Street 1:110 N ELM AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2418
Practice Address - Country:US
Practice Address - Phone:314-222-4458
Practice Address - Fax:314-773-3663
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health