Basic Information
| Provider Information | |||||||||
| NPI: | 1174263230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMY MICHEL LMFT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16470 SE PLEASANT VALLEY PKWY | ||||||||
| Address2: | |||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970864393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039983415 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4605 NE FREMONT ST STE 210F | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972131707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039983415 | ||||||||
| FaxNumber: | 5039269313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2022 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | MICHEL | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED MARRIAGE & FAMILY THERAPIS | ||||||||
| AuthorizedOfficialTelephone: | 5039983415 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.