Healthcare Provider Details

I. General information

NPI: 1164770244
Provider Name (Legal Business Name): MICHELLE MARIE KLEIN M.ED., LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE MARIE MORTON

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3943 S ATHERTON ST
STATE COLLEGE PA
16801-8308
US

IV. Provider business mailing address

212 HOMESTEAD LN
BOALSBURG PA
16827-1525
US

V. Phone/Fax

Practice location:
  • Phone: 814-466-9322
  • Fax: 814-466-9323
Mailing address:
  • Phone: 814-441-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC006608
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierPC006608
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerSTATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: