=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689913717
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DK MICHELLE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2013
-----------------------------------------------------
Last Update Date | 02/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 795 SHARON DR SUITE 208
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-1542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-801-4251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 795 SHARON DR SUITE 208
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-1542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MS. KIMBERLEY MICHELLE HARDY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 330-801-4251
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | C.0900521
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------