Provider Demographics
NPI:1306160197
Name:SIKORA, POLLY (MA, LPC)
Entity type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:SIKORA
Suffix:
Gender:F
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 1:41263 ROAD G
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-8928
Mailing Address - Country:US
Mailing Address - Phone:970-759-7328
Mailing Address - Fax:970-712-5413
Practice Address - Street 1:104 S MAIN STREET
Practice Address - Street 2:SUITE 5B
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328
Practice Address - Country:US
Practice Address - Phone:970-759-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5583101YP2500X
CO0435543101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool