Provider Demographics
NPI:1912020660
Name:MIKUS, KAREN CLARK (PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:CLARK
Last Name:MIKUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 PAULINE BLVD
Mailing Address - Street 2:SUITE 21-B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5047
Mailing Address - Country:US
Mailing Address - Phone:734-761-7247
Mailing Address - Fax:
Practice Address - Street 1:1945 PAULINE BLVD
Practice Address - Street 2:SUITE 21-B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5047
Practice Address - Country:US
Practice Address - Phone:734-761-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical