Provider Demographics
NPI:1184493868
Name:CARTER, MIKAYLA (RBT)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:CARTER
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 1:2502 BACON RANCH RD APT 1606
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-2916
Mailing Address - Country:US
Mailing Address - Phone:814-414-5144
Mailing Address - Fax:
Practice Address - Street 1:904 MOUNTAIN LION CIR STE 500
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5725
Practice Address - Country:US
Practice Address - Phone:814-414-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty