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General NPI Number Information
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NPI Number | 1821292111
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Entity Type | Individual
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Provider Name | MICHELLE LYNN MACIEL PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | PO BOX 257 PMB 10925
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City | OLYMPIA
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State | WA
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Zip | 98507-0257
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Country | US
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Telephone | 310-993-2898
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 257 PMB 10925
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City | OLYMPIA
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State | WA
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Zip | 98507-0257
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Country | US
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Telephone | 310-993-2898
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60524587
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY29406
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License Number State | CA
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