Provider Demographics
NPI:1780271700
Name:EBNER, MIKAYLA SHEA (BCBA, MSED)
Entity type:Individual
Prefix:MRS
First Name:MIKAYLA
Middle Name:SHEA
Last Name:EBNER
Suffix:
Gender:F
Credentials:BCBA, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8823
Mailing Address - Country:US
Mailing Address - Phone:618-917-3037
Mailing Address - Fax:
Practice Address - Street 1:310 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-8823
Practice Address - Country:US
Practice Address - Phone:618-917-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-24-72001103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst