Provider Demographics
NPI:1053991257
Name:MICHELLE DAGUE LCSW PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MICHELLE DAGUE LCSW PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-884-3946
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:OR
Mailing Address - Zip Code:97533-0445
Mailing Address - Country:US
Mailing Address - Phone:503-884-3946
Mailing Address - Fax:503-200-1302
Practice Address - Street 1:777 NE 7TH ST STE 208
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1632
Practice Address - Country:US
Practice Address - Phone:503-884-3946
Practice Address - Fax:503-200-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty