Individual
ERIC MIKKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAMFT
Contact information
Practice address
321 N 3RD ST, MCCALL, ID 83638-4439
(208) 634-2962
Mailing address
PO BOX 637, DONNELLY, ID 83615-0637
(208) 315-5759
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LAMFT-4723
ID
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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