Healthcare Provider Details

I. General information

NPI: 1013582600
Provider Name (Legal Business Name): LYNSEY MIKELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 E HEIM AVE STE 205
ORANGE CA
92865-3016
US

IV. Provider business mailing address

1815 E HEIM AVE STE 205
ORANGE CA
92865-3016
US

V. Phone/Fax

Practice location:
  • Phone: 714-640-6891
  • Fax:
Mailing address:
  • Phone: 714-640-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: