| Organization Name: | WANDA JEANNE MICHAELS MD PA |
| NPI Number: | 1720011091 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WANDA JEANNE MICHAELS (MEDICAL DIRECTOR/OWNER) |
| Mailing Address: | 13646 Fm 849 Lindale |
| State: | TX US |
| Postal Code: | 757715052 |
| Phone Number: | 8006891527 |
| Fax Number: | 8006891527 |
| NPI Enumeration Date: | 07/09/2006 |
| NPI Last Update Date: | 08/31/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | J4922 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |