Basic Information
| Provider Information | |||||||||
| NPI: | 1508043324 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOX | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LISW-SUPV | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4685 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452123397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138539595 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8240 NORTHCREEK DR STE 1400 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137924700 | ||||||||
| FaxNumber: | 5133461396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2008 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I-1000149-SUPV | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.