Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | LH60432645 | WA |
N | 101YP1600X | Pastoral Counselor |
NPI | 1326275355 |
---|---|
Provider Name | Michelle Broweleit |
First Address | Ellensburg, WA 98926-5802 |
Second Address | Ellensburg, WA 98926-5802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 28/12/2013 |