Provider Demographics
NPI:1154760858
Name:MICKOWSKI, NORA REVELL (LCSW)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:REVELL
Last Name:MICKOWSKI
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:REVELL
Other - Last Name:MCCULLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10502 WALNUT BEND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4032
Mailing Address - Country:US
Mailing Address - Phone:603-547-5173
Mailing Address - Fax:
Practice Address - Street 1:10502 WALNUT BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4032
Practice Address - Country:US
Practice Address - Phone:603-547-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX67310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health