Provider Demographics
NPI:1093852451
Name:DAY, MICKEY (D MIN)
Entity Type:Individual
Prefix:
First Name:MICKEY
Middle Name:
Last Name:DAY
Suffix:
Gender:M
Credentials:D MIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7360 SW HUNZIKER ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8288
Mailing Address - Country:US
Mailing Address - Phone:503-620-3302
Mailing Address - Fax:503-620-3196
Practice Address - Street 1:7360 SW HUNZIKER ST
Practice Address - Street 2:SUITE 207
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8288
Practice Address - Country:US
Practice Address - Phone:503-620-3302
Practice Address - Fax:503-620-3196
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCO881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0306OtherMARRIAGE FAMILY THERAPIST
ORCO881OtherPROFESSIONAL COUNSELOR