Provider Demographics
NPI:1558095067
Name:MIKKELBORG, INGVILD (MA)
Entity Type:Individual
Prefix:
First Name:INGVILD
Middle Name:
Last Name:MIKKELBORG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W STATE ROUTE 89A # 1157
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-6135
Mailing Address - Country:US
Mailing Address - Phone:928-567-1322
Mailing Address - Fax:
Practice Address - Street 1:3090 E CORONADO TRL # AZ86335
Practice Address - Street 2:
Practice Address - City:RIMROCK
Practice Address - State:AZ
Practice Address - Zip Code:86335-5283
Practice Address - Country:US
Practice Address - Phone:928-567-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health