Provider Demographics
NPI:1053603696
Name:HASTINGS, MICHELLE A (LPC-T)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1115
Mailing Address - Country:US
Mailing Address - Phone:920-720-3700
Mailing Address - Fax:920-720-3806
Practice Address - Street 1:902 RIVERSIDE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1992
Practice Address - Country:US
Practice Address - Phone:715-256-1475
Practice Address - Fax:715-256-0705
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4924101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor