Provider Demographics
NPI:1659618874
Name:MICKA, NOELLE
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:MICKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E PLUMB LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3536
Mailing Address - Country:US
Mailing Address - Phone:775-825-3043
Mailing Address - Fax:775-345-3147
Practice Address - Street 1:620 E PLUMB LN
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3536
Practice Address - Country:US
Practice Address - Phone:775-825-3043
Practice Address - Fax:775-345-3147
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health