Provider Demographics
NPI:1235890294
Name:SEWELL, MIKAYLA (BCBA 1-22-61267)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:SEWELL
Suffix:
Gender:F
Credentials:BCBA 1-22-61267
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:
Other - Last Name:LAMBETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA 1-22-61267
Mailing Address - Street 1:8300 JEFFERSON ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1734
Mailing Address - Country:US
Mailing Address - Phone:402-432-0377
Mailing Address - Fax:
Practice Address - Street 1:1001 FORT CROOK RD N STE 204
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4226
Practice Address - Country:US
Practice Address - Phone:402-347-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NE1-22-61267103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician