Provider Demographics
NPI:1992215602
Name:MICKOLA, NATALIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MICKOLA
Suffix:
Gender:
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 1:333 S STATE ST
Mailing Address - Street 2:STE V #203
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034
Mailing Address - Country:US
Mailing Address - Phone:503-487-8759
Mailing Address - Fax:971-351-7027
Practice Address - Street 1:333 S STATE ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034
Practice Address - Country:US
Practice Address - Phone:503-487-8759
Practice Address - Fax:971-351-7027
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2025-04-30
Deactivation Date:2023-07-21
Deactivation Code:
Reactivation Date:2025-03-27
Provider Licenses
StateLicense IDTaxonomies
ORC7589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health