Provider Demographics
NPI:1548463961
Name:QUAKER VALLEY COUNSELING SERVICES
Entity type:Organization
Organization Name:QUAKER VALLEY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-985-7181
Mailing Address - Street 1:E1475 OWENS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA VALLE
Mailing Address - State:WI
Mailing Address - Zip Code:53941-9529
Mailing Address - Country:US
Mailing Address - Phone:608-985-8187
Mailing Address - Fax:
Practice Address - Street 1:E1475 OWENS DRIVE
Practice Address - Street 2:
Practice Address - City:LA VALLE
Practice Address - State:WI
Practice Address - Zip Code:53941-9529
Practice Address - Country:US
Practice Address - Phone:608-985-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2350 - 1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty