Provider Demographics
NPI:1114153848
Name:MIKEL, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MIKEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0258
Mailing Address - Country:US
Mailing Address - Phone:620-421-3770
Mailing Address - Fax:620-421-0665
Practice Address - Street 1:1730 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4229
Practice Address - Country:US
Practice Address - Phone:620-421-3770
Practice Address - Fax:620-421-0665
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical