Provider Demographics
NPI:1609668896
Name:COUNTRYMAN, MIKAYLA DEAN
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:DEAN
Last Name:COUNTRYMAN
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 1:255 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1243
Mailing Address - Country:US
Mailing Address - Phone:785-376-1233
Mailing Address - Fax:
Practice Address - Street 1:255 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1243
Practice Address - Country:US
Practice Address - Phone:785-376-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst