Michelle Renee Davis, LPCC-S

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.2102428-SUPV Issued in OH

Practice address

519 Newhaven St
Oak Park, CA 91377-4821

Phone

(216) 409-5820

NPI assigned

Nov 13, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Michelle Renee Mate Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Phoenix Counseling LLC

  • Community/Behavioral Health Agency
  • Thousand Oaks, CA
  • NPI 1831089515
  NPD Authorized official
• Analytical Sciences Inc

  • Counselor
  • Avon, OH
  • NPI 1730536723
  NPD (past)
• Psychological Counseling Solutions, LLC

  • Clinical Social Worker
  • Avon, OH
  • NPI 1861639866
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1510531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1154834158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37303 HARVEST AVE",
            "city": "AVON",
            "state": "OH",
            "postal_code": "440112803",
            "telephone_number": "440-847-8505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 NEWHAVEN ST",
            "city": "OAK PARK",
            "state": "CA",
            "postal_code": "913774821",
            "telephone_number": "216-409-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MICHELLE",
        "middle_name": "RENEE",
        "credential": "LPCC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-13",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.2102428-SUPV",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.015142",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0286648",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "MATE",
            "middle_name": "RENEE",
            "credential": "LPCC-S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Frank Cobasko, M.D.
• Rachel Convey
• Amanda Crane, LCSW
• Kristin Marie Cullen-Dunmeyer
• Trevor Curry
• Jade Leah Dearing, MA LMFT
• Erica Detweiler, PT, DPT
• Dieta Inc.
• Marla Dishman, RD
• Dr. Kiana Kiasaleh, Chiropractic Inc.

• Professional Counselor in Oak Park, CA
• Providers in Oak Park, CA by specialty
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.