Provider Demographics
NPI:1497237457
Name:MIKOLASY, LLC
Entity Type:Organization
Organization Name:MIKOLASY, LLC
Other - Org Name:RETURN TO ROOTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MIKOLASY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:509-230-9722
Mailing Address - Street 1:PO BOX 4231
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-0231
Mailing Address - Country:US
Mailing Address - Phone:509-230-9722
Mailing Address - Fax:
Practice Address - Street 1:400 S JEFFERSON ST STE 451
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3143
Practice Address - Country:US
Practice Address - Phone:619-693-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60812427261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235598046Medicaid