Provider Demographics
NPI:1992052609
Name:ST. JOHN, MICHAEL PAUL (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:ST. JOHN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 7TH AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1176
Mailing Address - Country:US
Mailing Address - Phone:906-786-6441
Mailing Address - Fax:906-786-5859
Practice Address - Street 1:2500 7TH AVE S
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1176
Practice Address - Country:US
Practice Address - Phone:906-786-6441
Practice Address - Fax:906-786-5859
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010942721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical