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General NPI Number Information
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NPI Number | 1063285070
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Entity Type | Organization
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Legal Business Name | MIRA COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 1244 N MAIN ST
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City | TOOELE
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State | UT
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Zip | 84074-9838
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Country | US
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Telephone | 801-448-6523
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Fax |
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Provider Business Mailing Address
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Address Line | 884 W SAGEWOOD DR
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City | STANSBURY PARK
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State | UT
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Zip | 84074-4921
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Country | US
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Telephone | 801-448-6523
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HILARY SIKOCHI
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Credential | LCSW
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Telephone | 801-448-6523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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