MEDICARE: MICHELLE NEALEY 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	171M00000X	Case Manager/Care Coordinator
2	101Y00000X	Counselor	C.1801495	OH

General Provider Information

NPI Number	:	1225544141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE NEALEY LPC

Provider Business Mailing Address
First Line	:	567 WABASH AVE NW
Second Line	:
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-4143
Country	:	US
Telephone Number	:	330-343-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	567 WABASH AVE NW
Second Line	:
City	:	NEW PHILADELPHIA
State	:	OH
Zip	:	44663-4143
Country	:	US
Telephone Number	:	330-343-3050
Fax Number	:

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

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	09/24/2018

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