Provider Demographics
NPI:1063285070
Name:MIRA COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:MIRA COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKOCHI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-448-6523
Mailing Address - Street 1:884 W SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-4921
Mailing Address - Country:US
Mailing Address - Phone:801-448-6523
Mailing Address - Fax:
Practice Address - Street 1:1244 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9838
Practice Address - Country:US
Practice Address - Phone:801-448-6523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty