Provider Demographics
NPI:1679315162
Name:ROBERTS, MIKAYLA L (RBT)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:L
Last Name:ROBERTS
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 1:2 AARONA PL STE 208
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2545
Mailing Address - Country:US
Mailing Address - Phone:808-263-5521
Mailing Address - Fax:
Practice Address - Street 1:2 AARONA PL STE 208
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2545
Practice Address - Country:US
Practice Address - Phone:808-263-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-24-349277106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician