Healthcare Provider Details

I. General information

NPI: 1902269707
Provider Name (Legal Business Name): MICHELLE HILLAR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE BOUCHOR LMHC

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 SE PETROVITSKY RD STE 104
RENTON WA
98058
US

IV. Provider business mailing address

27023 164TH AVE SE
COVINGTON WA
98042-8241
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4055
  • Fax: 425-656-5425
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60591045
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: