Healthcare Provider Details

I. General information

NPI: 1801930177
Provider Name (Legal Business Name): TAMARA CODER MIKINSKI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10965 GRANADA LANE SUITE 101
OVERLAND PARK KS
66211-1412
US

IV. Provider business mailing address

P.O. BOX 272
DESOTO KS
66018
US

V. Phone/Fax

Practice location:
  • Phone: 913-777-6665
  • Fax: 913-345-0090
Mailing address:
  • Phone: 816-223-1407
  • Fax: 913-345-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number01693
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301015897
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number884
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number884
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number884
License Number StateKS
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number884
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: