Individual
MICHAEL MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2360 E PERSHING BLVD, CHEYENNE, WY 82001-5356
(307) 778-7550
Mailing address
2360 E PERSHING BLVD, CHEYENNE, WY 82001-5356
(307) 778-7550
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW1145
WY
Other
Enumeration date
11/27/2012
Last updated
04/27/2020
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