Healthcare Provider Details

I. General information

NPI: 1891377313
Provider Name (Legal Business Name): CAITLIN MIKULICICH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

IV. Provider business mailing address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

V. Phone/Fax

Practice location:
  • Phone: 760-450-7303
  • Fax:
Mailing address:
  • Phone: 760-450-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116051
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133130
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: