Individual
WALTER J MICKULICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., MPA
Contact information
Practice address
5600 BRAINERD RD STE B42, CHATTANOOGA, TN 37411-5356
(423) 605-1855
(423) 296-6515
Mailing address
5600 BRAINERD RD STE B42, CHATTANOOGA, TN 37411-5356
(423) 605-1855
(423) 296-6515
Taxonomy
Speciality
Code
Description
License number
State
101YS0200X
School Counselor
7147485
TN
103TC0700X
Clinical Psychologist
7137531
TN
103TF0200X
Forensic Psychologist
Primary
7696871
TN
103TS0200X
School Psychologist
7147485
TN
Other
Enumeration date
04/26/2012
Last updated
04/26/2012
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