Organization
DR. MICHELLE CHANNING PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE CHANNING PSY.D. (PRESIDENT)
(954) 385-6750
Entity
Organization
Contact information
Practice address
2741 EXECUTIVE PARK DR, SUITE 1, WESTON, FL 33331-3641
(954) 385-6750
(954) 385-6757
Mailing address
2741 EXECUTIVE PARK DR, SUITE 1, WESTON, FL 33331-3641
(954) 385-6750
(954) 385-6757
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY6745
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q0486
MEDICARE GROUP PTAN
—
Enumeration date
10/17/2006
Last updated
09/16/2021
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