Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2671-057 | WI |
N | 103TC0700X | Clinical Psychologist | 2671-057 | WI |
Y | 103G00000X | Clinical Psychologist | 36237 | TX |
Y | 103TC0700X | Clinical Psychologist | 36237 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 36237 | TX |
NPI | 1093855710 |
---|---|
Provider Name | Dr. Elena Mikalsen |
First Address | Houston, TX 77046-0297 |
Second Address | San Antonio, TX 78207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 09/10/2020 |