Provider Demographics
NPI:1174048839
Name:MCRILL, MICHAEL (LMSW, LMAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCRILL
Suffix:
Gender:M
Credentials:LMSW, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W 4TH ST APT D8
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-4630
Mailing Address - Country:US
Mailing Address - Phone:310-579-5872
Mailing Address - Fax:
Practice Address - Street 1:1701 W 4TH ST APT D8
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-4630
Practice Address - Country:US
Practice Address - Phone:310-579-5872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10229104100000X
KS266101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker