Provider Demographics
NPI:1568714681
Name:MIKESELL, CECELIA (CSW)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:MIKESELL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-0911
Mailing Address - Country:US
Mailing Address - Phone:307-320-7994
Mailing Address - Fax:
Practice Address - Street 1:1815 DALEY ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5911
Practice Address - Country:US
Practice Address - Phone:307-324-5899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCSW1661041C0700X
WYCSW-1661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical