| Mikaela Ivy-kian Adais Addams, | |
|
212 N Indio Ave, Portales, NM 88130-5634 | |
| (505) 690-0588 | |
| Not Available |
| Full Name | Mikaela Ivy-kian Adais Addams |
|---|---|
| Gender | Female |
| Speciality | Mental Health Counselor |
| Experience | 5 Years |
| Location | 212 N Indio Ave, Portales, New Mexico |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346007069 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | CTB-2023-0693 (New Mexico) | Primary |
| Entity Name | Wild Magnolia Wellness |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1255820205 PECOS PAC ID: 8729492491 Enrollment ID: O20210121001173 |
| Mailing Address | Practice Location Address |
|---|---|
| Mikaela Ivy-kian Adais Addams, 212 N Indio Ave, Portales, NM 88130-5634 Ph: (505) 690-0588 | Mikaela Ivy-kian Adais Addams, 212 N Indio Ave, Portales, NM 88130-5634 Ph: (505) 690-0588 |
Zoe Kambria Rodriguez, LMSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 1500 S Avenue K, Station 9, Portales, NM 88130 Phone: 575-562-4455 Fax: 575-562-4460 |
Maggie S Hernandez, YCS Counselor Medicare: Not Enrolled in Medicare Practice Location: 1111 W Fir St, Portales, NM 88130 Phone: 575-356-5112 |
Philip Ean Forrest, Counselor Medicare: Not Enrolled in Medicare Practice Location: 220 W 2nd St, Portales, NM 88130 Phone: 575-356-2222 |
Colton Trevenne Coleman, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1111 W Fir St, Portales, NM 88130 Phone: 575-356-5112 |
Rebekah J Hodge, BMS Counselor Medicare: Medicare Enrolled Practice Location: 220 W 2nd St, Portales, NM 88130 Phone: 575-356-2223 |
Sabreena Leann Aranda, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1111 W Fir St, Portales, NM 88130 Phone: 575-356-5112 |
Matthew Pacheco, Counselor Medicare: Not Enrolled in Medicare Practice Location: 220 W. Second Street, Portales, NM 88130 Phone: 575-356-2222 Fax: 575-356-2224 |