Basic Information
| Provider Information | |||||||||
| NPI: | 1932564341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHEL | ||||||||
| FirstName: | ELLEN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30826 LINDER RD | ||||||||
| Address2: | |||||||||
| City: | DENHAM SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707268507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256657878 | ||||||||
| FaxNumber: | 2256657856 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 BROWNSWITCH RD STE B | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704611695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856610560 | ||||||||
| FaxNumber: | 9856610560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2015 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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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 | 101Y00000X | LA | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1548839 | 05 | LA | MEDICAID |