Provider Demographics
NPI:1609555275
Name:PUGH, MAKAYLA (RBT)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 GEORGE ELLIS DR
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38058-3029
Mailing Address - Country:US
Mailing Address - Phone:901-687-8709
Mailing Address - Fax:
Practice Address - Street 1:1880 OLD HIGHWAY 51 S STE F
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:TN
Practice Address - Zip Code:38011-8025
Practice Address - Country:US
Practice Address - Phone:901-290-3916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-22-221387106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician