Provider Demographics
NPI:1902323082
Name:MIKKELSON, JUNE (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:MIKKELSON
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:
Other - Last Name:MIKKELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:1221 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1418
Mailing Address - Country:US
Mailing Address - Phone:712-255-0204
Mailing Address - Fax:712-255-1120
Practice Address - Street 1:1221 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1418
Practice Address - Country:US
Practice Address - Phone:712-255-0204
Practice Address - Fax:712-255-1120
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health