Doctor Name: | ANDREW MICKA |
NPI Number: | 1356709570 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 15-06-10 |
Business Practice Address: | 3700 Midway Dr Baker City, OR - 978141456 |
Business Phone Number: | 5415238320 |
Business Fax Number: | |
Mailing Address: | 3700 Midway Dr, BAKER CITY |
State: | OR |
Postal Code: | 978141456 |
Phone Number: | 5415238320 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2016 |
NPI Last Update Date: | 02/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 15-06-10 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |