Organization
QUAKER VALLEY COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRON MICKELSON LCSW (PSYCHOTHERAPIST)
(608) 985-7181
Entity
Organization
Contact information
Practice address
E1475 OWENS DRIVE, LA VALLE, WI 53941-9529
(608) 985-8187
Mailing address
E1475 OWENS DRIVE, LA VALLE, WI 53941-9529
(608) 985-8187
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2350 - 123
WI
Other
Enumeration date
06/06/2007
Last updated
08/22/2020
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