Healthcare Provider Details

I. General information

NPI: 1861667636
Provider Name (Legal Business Name): MICHELLE BOREN LMHC, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE OWEN

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 LINCOLNWAY
LA PORTE IN
46350
US

IV. Provider business mailing address

316 LINCOLNWAY
LA PORTE IN
46350
US

V. Phone/Fax

Practice location:
  • Phone: 219-707-0178
  • Fax: 219-325-0855
Mailing address:
  • Phone: 219-707-0178
  • Fax: 219-325-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000643A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001957A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: