Walter J Mickulick, M.A., MPA

NPI #1043578123 in Chattanooga, Tennessee

Provider Information

NPI Number: 1043578123
Entity Type: Individual
Name: Walter J Mickulick, M.A., MPA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - Forensic
Credential: M.A., MPA
Enumeration Date: Apr 26, 2012
Last Updated: Apr 26, 2012

Practice Location

Address: 5600 BRAINERD RD STE B42
City: Chattanooga
State: Tennessee
ZIP Code: 37411-5356
Phone: (423) 605-1855

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - School — School	101YS0200X
Psychologist - Clinical — Clinical	103TC0700X
Psychologist - Forensic — Forensic	103TF0200X	Primary
Psychologist - School — School	103TS0200X

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