Healthcare Provider Details

I. General information

NPI: 1639316656
Provider Name (Legal Business Name): MICHELLE ANN STIAES PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 GENERAL MEYER AVE
NEW ORLEANS LA
70131-3529
US

IV. Provider business mailing address

4460 GENERAL MEYER AVE
NEW ORLEANS LA
70131-3529
US

V. Phone/Fax

Practice location:
  • Phone: 504-364-6613
  • Fax: 504-364-6651
Mailing address:
  • Phone: 504-364-6613
  • Fax: 504-364-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number865
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: