Individual
MICHELLE THEDANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
920 W EXECUTIVE CT, MONTICELLO, IN 47960-1961
(765) 583-9350
Mailing address
415 N 26TH ST STE 102, LAFAYETTE, IN 47904-2855
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39004054A
IN
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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