Provider Demographics
NPI:1346924099
Name:SALVADOR, MYCAILAH GRACE (TLMHC)
Entity Type:Individual
Prefix:MISS
First Name:MYCAILAH
Middle Name:GRACE
Last Name:SALVADOR
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:MYCAILAH
Other - Middle Name:GRACE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825.5 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613
Mailing Address - Country:US
Mailing Address - Phone:319-601-6438
Mailing Address - Fax:
Practice Address - Street 1:409 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2812
Practice Address - Country:US
Practice Address - Phone:319-220-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health