MEDICARE: MYKAELA LARA BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	5561	TX
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1548779382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYKAELA LARA BCBA

Provider Business Mailing Address
First Line	:	1502 N 18TH ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79601-2835
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 N 3RD ST
Second Line	:
City	:	ABILENE
State	:	TX
Zip	:	79603-7054
Country	:	US
Telephone Number	:	325-650-4735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	09/15/2025

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Directions to “ MYKAELA LARA BCBA” Practice Location

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