Provider Demographics
NPI:1447686464
Name:FITTING, MICHELLE RENE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENE
Last Name:FITTING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1938
Mailing Address - Country:US
Mailing Address - Phone:208-746-7661
Mailing Address - Fax:208-746-0811
Practice Address - Street 1:1002 IDAHO ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1938
Practice Address - Country:US
Practice Address - Phone:208-746-7661
Practice Address - Fax:208-746-0811
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30714104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker