Provider Demographics
NPI:1962010330
Name:MARY MIKA, PSY.D. PLLC
Entity Type:Organization
Organization Name:MARY MIKA, PSY.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-433-9582
Mailing Address - Street 1:603 CLAIRE LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-1667
Mailing Address - Country:US
Mailing Address - Phone:708-433-9582
Mailing Address - Fax:
Practice Address - Street 1:720 OSTERMAN AVE STE 301
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4339
Practice Address - Country:US
Practice Address - Phone:708-433-9582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty