Healthcare Provider Details

I. General information

NPI: 1497237457
Provider Name (Legal Business Name): MIKOLASY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S JEFFERSON ST STE 451
SPOKANE WA
99204-3143
US

IV. Provider business mailing address

PO BOX 4231
SPOKANE WA
99220-0231
US

V. Phone/Fax

Practice location:
  • Phone: 619-693-7576
  • Fax:
Mailing address:
  • Phone: 509-230-9722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number60812427
License Number StateWA

VIII. Authorized Official

Name: RACHEL E MIKOLASY
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 509-230-9722