Provider Demographics
NPI:1053137562
Name:THIRD CULTURE SOMATICS
Entity type:Organization
Organization Name:THIRD CULTURE SOMATICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKULINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:720-773-0578
Mailing Address - Street 1:2735 IRIS AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2436
Mailing Address - Country:US
Mailing Address - Phone:720-773-0578
Mailing Address - Fax:
Practice Address - Street 1:2735 IRIS AVE STE C3
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2436
Practice Address - Country:US
Practice Address - Phone:720-773-0578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty