Provider Demographics
NPI:1689775587
Name:DAIGLE, MICHELLE (MA,LPC,CCC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:MA,LPC,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W 2ND ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3333
Mailing Address - Country:US
Mailing Address - Phone:307-682-6699
Mailing Address - Fax:307-687-7243
Practice Address - Street 1:1401 W 2ND ST
Practice Address - Street 2:SUITE #1
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3333
Practice Address - Country:US
Practice Address - Phone:307-682-6699
Practice Address - Fax:307-687-7243
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY010581119OtherTAX ID NUMBER