Individual
MICAH A GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
1040 S WINTER ST STE 1022, ADRIAN, MI 49221-3876
(517) 263-8905
Mailing address
1040 S WINTER ST STE 1022, ADRIAN, MI 49221-3876
(517) 263-8905
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2017042234
MO
101YP2500X
Professional Counselor
Primary
6401223314
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017042234
PLPC LICENSE
MO
05
—
490054503
—
MO
Enumeration date
12/13/2017
Last updated
07/12/2023
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