Provider Demographics
NPI:1952043309
Name:GRAY, MIKEA RENEE (BCBA)
Entity Type:Individual
Prefix:
First Name:MIKEA
Middle Name:RENEE
Last Name:GRAY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3657 W CHAPMAN LN
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2300
Mailing Address - Country:US
Mailing Address - Phone:310-418-7285
Mailing Address - Fax:
Practice Address - Street 1:3657 W CHAPMAN LN
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2300
Practice Address - Country:US
Practice Address - Phone:310-418-7285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB551248103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst