Provider Demographics
NPI:1942375464
Name:HUNT-GRAHAM, MICHELLE SCHUBERT (LAMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SCHUBERT
Last Name:HUNT-GRAHAM
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 COUNTY ROAD D E
Mailing Address - Street 2:SUITE B
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5353
Mailing Address - Country:US
Mailing Address - Phone:651-748-5019
Mailing Address - Fax:651-773-7591
Practice Address - Street 1:7525 MITCHELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1959
Practice Address - Country:US
Practice Address - Phone:952-224-2282
Practice Address - Fax:952-224-2284
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0T636BEOtherBLUECROSS BLUE SHIELD
MNHP85042OtherHEALTH PARTNERS
MN862628000Medicaid
MN153059OtherBEHAVIORAL HEALTHCARE PROVIDERS (UCARE, PREFERRED ONE)