Provider Demographics
NPI:1679079164
Name:MICKO, MARTA (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MICKO
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-3815
Mailing Address - Country:US
Mailing Address - Phone:847-219-3423
Mailing Address - Fax:
Practice Address - Street 1:125 E EMERSON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-3815
Practice Address - Country:US
Practice Address - Phone:847-219-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013440101YP2500X
IL178013653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional