Provider Demographics
NPI:1497354062
Name:MCALLISTER, MICAELA MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:MARIE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:MICAELA
Other - Middle Name:MARIE
Other - Last Name:DAVIS-WEINKAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:9260 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-4478
Practice Address - Country:US
Practice Address - Phone:937-388-5110
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-20-138277106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician