Individual
MARIAH MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 E GRAND AVE STE 2B, BELOIT, WI 53511-6399
(608) 314-6207
Mailing address
1806 RITSHER ST, BELOIT, WI 53511-3236
(608) 314-6207
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/22/2024
Last updated
08/08/2024
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