Provider Demographics
NPI:1760072540
Name:HODGES, MAKAYLA NICHOLE
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:NICHOLE
Last Name:HODGES
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 1:6570 RAINBOW SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6970
Mailing Address - Country:US
Mailing Address - Phone:727-748-5456
Mailing Address - Fax:
Practice Address - Street 1:6570 RAINBOW SPRINGS LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6970
Practice Address - Country:US
Practice Address - Phone:727-748-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-152794106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician