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General NPI Number Information
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NPI Number | 1922478007
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Entity Type | Individual
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Provider Name | MICHELLE STORY
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Gender | Female
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 509 W MCKINLEY AVE STE 3
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City | MISHAWAKA
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State | IN
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Zip | 46545-5564
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Country | US
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Telephone | 574-248-4870
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Fax |
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Provider Business Mailing Address
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Address Line | 518 W RUSS AVE
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City | MISHAWAKA
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State | IN
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Zip | 46545-5558
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Country | US
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Telephone | 574-274-9134
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001874A
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License Number State | IN
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