MEDICARE: MR. JAMES MICHEL MA LP

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	103TC1900X	Counseling Psychologist	LP 2245	MN

General Provider Information

NPI Number	:	1619027158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MICHEL MA LP

Provider Business Mailing Address
First Line	:	2400 BLAISDELL AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-3331
Country	:	US
Telephone Number	:	612-250-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 BLAISDELL AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-3331
Country	:	US
Telephone Number	:	612-250-3800
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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