Provider Demographics
NPI:1093376733
Name:GARRETT, MIKA (MS, MED, BCBA, LBA)
Entity Type:Individual
Prefix:MS
First Name:MIKA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MS, MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1182 LULA LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5905
Mailing Address - Country:US
Mailing Address - Phone:615-310-5469
Mailing Address - Fax:
Practice Address - Street 1:1182 LULA LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5905
Practice Address - Country:US
Practice Address - Phone:615-310-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-19-36427103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ052483Medicaid