Basic Information
| Provider Information | |||||||||
| NPI: | 1205111325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 708 5TH ST | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470409489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125377375 | ||||||||
| FaxNumber: | 8125375271 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 W EADS PKWY | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470251139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125377375 | ||||||||
| FaxNumber: | 8125375271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2011 | ||||||||
| LastUpdateDate: | 03/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 34006897A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.