Provider Demographics
NPI:1215086681
Name:MIKITSON, JOHN WALTER (MA,LPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WALTER
Last Name:MIKITSON
Suffix:
Gender:M
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 HURON ST
Mailing Address - Street 2:ROOM 40
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3046
Mailing Address - Country:US
Mailing Address - Phone:720-217-2636
Mailing Address - Fax:303-254-2653
Practice Address - Street 1:11310 HURON ST
Practice Address - Street 2:ROOM 40
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-3046
Practice Address - Country:US
Practice Address - Phone:720-217-2636
Practice Address - Fax:303-254-2653
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health