Healthcare Provider Details

I. General information

NPI: 1013529361
Provider Name (Legal Business Name): MICHELLE MCQUEEN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 09/07/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 CR 1009
GODLEY TX
76044-7603
US

IV. Provider business mailing address

PO BOX 914
CLEBURNE TX
76033-0914
US

V. Phone/Fax

Practice location:
  • Phone: 817-307-3108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: