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General NPI Number Information
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NPI Number | 1073764320
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Entity Type | Individual
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Provider Name | MICHELLE RENEE PASS LPC,LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 05/16/2018
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Provider Practice Location Address
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Address Line | 420 N MAIN ST
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City | GREENWOOD
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State | AR
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Zip | 72936
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Country | US
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Telephone | 479-996-8884
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11818
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City | FORT SMITH
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State | AR
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Zip | 72917-1818
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Country | US
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Telephone | 479-452-6650
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Fax | 479-452-5847
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1007071
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M1306007
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | A1008019
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1306054
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License Number State | AR
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