Provider Demographics
NPI:1336800838
Name:HARGRAVE, MAKYLA MARIE (RBT)
Entity Type:Individual
Prefix:MS
First Name:MAKYLA
Middle Name:MARIE
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:MAKYLA
Other - Middle Name:MARIE
Other - Last Name:FLANAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1500 S DOUGLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:844-854-1116
Mailing Address - Fax:305-846-9711
Practice Address - Street 1:1716 CORPORATE XING STE 3
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3734
Practice Address - Country:US
Practice Address - Phone:618-226-4687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBACB683137106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician