Provider Demographics
NPI:1083482103
Name:TEVEZ, MCKAYLA
Entity Type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:
Last Name:TEVEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-1212
Mailing Address - Country:US
Mailing Address - Phone:478-484-8396
Mailing Address - Fax:
Practice Address - Street 1:1121 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-1212
Practice Address - Country:US
Practice Address - Phone:478-484-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician