Healthcare Provider Details

I. General information

NPI: 1053975540
Provider Name (Legal Business Name): MICHAELA M UTTLEY M.S.; LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 06/27/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 JOHN YOUNG WAY STE 300
EXTON PA
19341-2567
US

IV. Provider business mailing address

P.O. BOX 38
FLEETWOOD PA
19522-9998
US

V. Phone/Fax

Practice location:
  • Phone: 484-876-1354
  • Fax:
Mailing address:
  • Phone: 484-876-1354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC012879
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: