Doctor Name: | ANTHONY A MICHAEL |
NPI Number: | 1174877526 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 62605 |
Business Practice Address: | 49 Rebel Dr 122 Guyton Hall University, MS - 38677 |
Business Phone Number: | 9034073800 |
Business Fax Number: | |
Mailing Address: | 1500 Wilkes Ave, OXFORD |
State: | MS |
Postal Code: | 386557807 |
Phone Number: | 9034073800 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2012 |
NPI Last Update Date: | 11/07/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 62605 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |