Basic Information
| Provider Information | |||||||||
| NPI: | 1992421499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEGA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 758 | ||||||||
| Address2: | |||||||||
| City: | NEOSHO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648500758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174519450 | ||||||||
| FaxNumber: | 4174518903 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 S MAIDEN LN | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648013084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177826200 | ||||||||
| FaxNumber: | 4177826210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2022 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2022040487 | MO | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.