Doctor Name: | MRS. MICHELLE ELIZABETH CHURCHEY-MIMS |
NPI Number: | 1295859577 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | |
Business Practice Address: | 13136 Western Ave Blue Island, IL - 604062423 |
Business Phone Number: | 7089745856 |
Business Fax Number: | 3128290710 |
Mailing Address: | 2424 Lewis St, BLUE ISLAND |
State: | IL |
Postal Code: | 604061717 |
Phone Number: | 7083852079 |
Fax Number: | 3128290710 |
NPI Enumeration Date: | 03/19/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |