Provider Demographics
NPI:1851952725
Name:MIKHALCHUK, ILONA NIKOLAYEVNA (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:NIKOLAYEVNA
Last Name:MIKHALCHUK
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:MRS
Other - First Name:ILONA
Other - Middle Name:NIKOLAYEVNA
Other - Last Name:KALPAKCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5870 W GUMWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8228
Mailing Address - Country:US
Mailing Address - Phone:509-280-1176
Mailing Address - Fax:
Practice Address - Street 1:3928 E BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99217-6933
Practice Address - Country:US
Practice Address - Phone:509-280-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMG60973191101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program