Healthcare Provider Details

I. General information

NPI: 1679002125
Provider Name (Legal Business Name): MICHALA NICOLE WESTFALL LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 BUCHANAN ST
CARTHAGE IL
62321-1401
US

IV. Provider business mailing address

1450 N COUNTY ROAD 2050 E
CARTHAGE IL
62321-3551
US

V. Phone/Fax

Practice location:
  • Phone: 217-357-3176
  • Fax: 217-357-6609
Mailing address:
  • Phone: 217-357-6888
  • Fax: 217-357-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.110794
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: