Provider Demographics
NPI:1679370357
Name:HOUSE, MIKAYLA
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:HOUSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CONGRESSIONAL BLVD.
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5400
Mailing Address - Country:US
Mailing Address - Phone:317-249-2242
Mailing Address - Fax:844-289-6798
Practice Address - Street 1:12650 HAMILTON CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5400
Practice Address - Country:US
Practice Address - Phone:317-249-2242
Practice Address - Fax:844-289-6798
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician