Healthcare Provider Details

I. General information

NPI: 1114125291
Provider Name (Legal Business Name): MICHELE MANNIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 3RD AVE
SEATTLE WA
98104-2304
US

IV. Provider business mailing address

515 3RD AVE
SEATTLE WA
98104-2304
US

V. Phone/Fax

Practice location:
  • Phone: 206-464-1570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07-R-20
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: