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NPI Code Detail

MEDICARE: MS. TABITHA MCMICHAEL MA, LCPC

MEDICARE: MS. TABITHA MCMICHAEL MA, LCPC
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
1101YP2500XProfessional Counselor178012028IL

General Provider Information

NPI Number : 1225564792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TABITHA MCMICHAEL MA, LCPC
Provider Business Mailing Address
First Line : 12 W HARRISON ST
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1907
Country : US
Telephone Number : 217-728-4358
Fax Number : 217-728-2270
Provider Business Practice Location Address
First Line : 12 W HARRISON ST
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1907
Country : US
Telephone Number : 217-728-4358
Fax Number : 217-728-2270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2017
Last Update Date : 03/05/2020

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