Provider Demographics
NPI:1154445740
Name:HALLORAN, MICKI (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:MICKI
Middle Name:
Last Name:HALLORAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:MAVOURNEEN
Other - Last Name:HALLORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2605 DENALI ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2738
Mailing Address - Country:US
Mailing Address - Phone:907-279-1393
Mailing Address - Fax:907-272-1553
Practice Address - Street 1:2605 DENALI ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2738
Practice Address - Country:US
Practice Address - Phone:907-279-1393
Practice Address - Fax:907-272-1553
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional