| Organization Name: | QUAKER VALLEY COUNSELING SERVICES |
| NPI Number: | 1548463961 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MYRON MICKELSON (PSYCHOTHERAPIST) |
| Mailing Address: | E1475 Owens Drive La Valle |
| State: | WI US |
| Postal Code: | 539419529 |
| Phone Number: | 6089858187 |
| Fax Number: | |
| NPI Enumeration Date: | 06/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2350 - 123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |