Provider Demographics
NPI:1316608631
Name:MIKULSKI, AMY NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:MIKULSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10714 SHAENCROSSING
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-9576
Mailing Address - Country:US
Mailing Address - Phone:862-576-1899
Mailing Address - Fax:
Practice Address - Street 1:10714 SHAENCROSSING
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-9576
Practice Address - Country:US
Practice Address - Phone:862-576-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical