Basic Information
| Provider Information | |||||||||
| NPI: | 1154445740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALLORAN | ||||||||
| FirstName: | MICKI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HALLORAN | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | MAVOURNEEN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2605 DENALI ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995032738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072791393 | ||||||||
| FaxNumber: | 9072721553 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 DENALI ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995032738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072791393 | ||||||||
| FaxNumber: | 9072721553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 329 | AK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.