MEDICARE: MICHELLE ASHLEY SHIELDS MAKI M.ED, LPC, NCC

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	4106	AL

General Provider Information

NPI Number	:	1720649056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ASHLEY SHIELDS MAKI M.ED, LPC, NCC

Provider Business Mailing Address
First Line	:	1021 LEE ROAD 201
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-4161
Country	:	US
Telephone Number	:	334-610-1718
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 LEE ROAD 201
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-4161
Country	:	US
Telephone Number	:	334-610-1718
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	02/26/2024

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