Provider Demographics
NPI:1689485781
Name:MICHEL, KAELAN
Entity type:Individual
Prefix:
First Name:KAELAN
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 JENNY CT
Mailing Address - Street 2:
Mailing Address - City:MONTZ
Mailing Address - State:LA
Mailing Address - Zip Code:70068-8977
Mailing Address - Country:US
Mailing Address - Phone:504-228-3815
Mailing Address - Fax:
Practice Address - Street 1:111 JENNY CT
Practice Address - Street 2:
Practice Address - City:MONTZ
Practice Address - State:LA
Practice Address - Zip Code:70068-8977
Practice Address - Country:US
Practice Address - Phone:504-228-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst