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NPI Code Detail

MEDICARE: MICHELLI VAN WIEREN PSS

MEDICARE:   MICHELLI  VAN WIEREN  PSS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1841592813
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLI VAN WIEREN PSS
Provider Business Mailing Address
First Line : 365 NE COURT ST
Second Line :
City : PRINEVILLE
State : OR
Zip : 97754-1936
Country : US
Telephone Number : 541-447-7441
Fax Number :
Provider Business Practice Location Address
First Line : 365 NE COURT ST
Second Line :
City : PRINEVILLE
State : OR
Zip : 97754-1936
Country : US
Telephone Number : 541-447-7441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2010
Last Update Date : 11/24/2010

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Directions to “ MICHELLI VAN WIEREN PSS” Practice Location

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