Healthcare Provider Details

I. General information

NPI: 1699322735
Provider Name (Legal Business Name): MICHELLE MATHENY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 KERRY ST STE 200
LANSING MI
48912-3671
US

IV. Provider business mailing address

2510 KERRY ST STE 200
LANSING MI
48912-3671
US

V. Phone/Fax

Practice location:
  • Phone: 810-214-2832
  • Fax:
Mailing address:
  • Phone: 810-214-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401019426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: