Provider Demographics
NPI:1063958122
Name:MIKULA, RAYMOND (LCPC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MIKULA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 WEATHERSTONE LN STE SE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2059
Mailing Address - Country:US
Mailing Address - Phone:847-845-2618
Mailing Address - Fax:
Practice Address - Street 1:1590 WEATHERSTONE LN STE SE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2059
Practice Address - Country:US
Practice Address - Phone:847-845-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014285101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional