Provider Demographics
NPI:1295534287
Name:JEFFERSON, MYKAH BRION (LMT)
Entity type:Individual
Prefix:
First Name:MYKAH
Middle Name:BRION
Last Name:JEFFERSON
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 TIERWESTER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2402
Mailing Address - Country:US
Mailing Address - Phone:281-222-7985
Mailing Address - Fax:
Practice Address - Street 1:16626 SEA LARK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-5819
Practice Address - Country:US
Practice Address - Phone:281-488-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty