MEDICARE: MRS. MONICA MARIA MICHAEL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6401011330	MI

General Provider Information

NPI Number	:	1043454325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA MARIA MICHAEL LPC

Provider Business Mailing Address
First Line	:	PO BOX 930
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-0930
Country	:	US
Telephone Number	:	616-970-1599
Fax Number	:

Provider Business Practice Location Address
First Line	:	6140 28TH ST SE STE 110
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-6938
Country	:	US
Telephone Number	:	616-970-1599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	12/28/2023

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