Provider Demographics
NPI:1417144932
Name:MIKELS, PAUL WESLEY (MSSA MSW FROM CWRU)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WESLEY
Last Name:MIKELS
Suffix:
Gender:M
Credentials:MSSA MSW FROM CWRU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10860 VICTORY ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:MI
Mailing Address - Zip Code:48133
Mailing Address - Country:US
Mailing Address - Phone:419-250-0169
Mailing Address - Fax:
Practice Address - Street 1:7521 N TELEGRAPH
Practice Address - Street 2:SUITE 1
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48166
Practice Address - Country:US
Practice Address - Phone:734-586-0031
Practice Address - Fax:734-586-0032
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010611521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical