Provider Demographics
NPI:1184061871
Name:DISBROW, MICAH NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:NICOLE
Last Name:DISBROW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:NICOLE
Other - Last Name:SARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PLPC
Mailing Address - Street 1:10220 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-8203
Mailing Address - Country:US
Mailing Address - Phone:319-461-7177
Mailing Address - Fax:573-265-0156
Practice Address - Street 1:13160 COUNTRY ROAD 3610
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559-0189
Practice Address - Country:US
Practice Address - Phone:573-265-3251
Practice Address - Fax:573-265-0156
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013011886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional