Provider Demographics
NPI:1801930177
Name:MIKINSKI, TAMARA CODER (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:CODER
Last Name:MIKINSKI
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:P.O. BOX 272
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018
Mailing Address - Country:US
Mailing Address - Phone:816-223-1407
Mailing Address - Fax:913-345-0090
Practice Address - Street 1:10965 GRANADA LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1412
Practice Address - Country:US
Practice Address - Phone:913-777-6665
Practice Address - Fax:913-345-0090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC1900X
MO01693103T00000X
MI6301015897103T00000X
KS884103TC1900X, 103TF0000X, 103TP2701X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy