Michaela Mirkovich Petz, MSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

RC00050552 Issued in WA

Practice address

1133 Railroad Ave Ste 100
Bellingham, WA 98225-5054

Phone

(360) 676-2164

NPI assigned

Nov 30, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Michaela Anne Mirkovich Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598832842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 RAILROAD AVE STE 100",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982255054",
            "telephone_number": "360-676-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 RAILROAD AVE STE 100",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982255054",
            "telephone_number": "360-676-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETZ",
        "first_name": "MICHAELA",
        "middle_name": "MIRKOVICH",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "RC00050552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHAELA",
            "last_name": "MIRKOVICH",
            "middle_name": "ANNE",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nadya A. Petkova, MA
• Petrichor Psychotherapy, LLC
• Avery Cortez Petro
• Victoria Petruchok
• John Mark Pettit, MD
• Tannis Leigh Peura, BA
• Weston Crocker Pew, LMHC
• Peter Richard Pfeiffer, MD
• Jeanie Pflueger, DPT
• Cathy Phan, ARNP

• Mental Health Counselor in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.