Provider Demographics
NPI:1902548399
Name:MICHEL, EPHRAIM
Entity Type:Individual
Prefix:
First Name:EPHRAIM
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 1:985 WIGWAM PKWY UNIT 1105
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6833
Mailing Address - Country:US
Mailing Address - Phone:267-975-3181
Mailing Address - Fax:
Practice Address - Street 1:985 WIGWAM PKWY UNIT 1105
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6833
Practice Address - Country:US
Practice Address - Phone:267-975-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA058446311Medicaid