Healthcare Provider Details

I. General information

NPI: 1215511639
Provider Name (Legal Business Name): CHRISTA A MAHLER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTA A DOUGHERTY

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W YAKIMA
JEROME ID
83338-6159
US

IV. Provider business mailing address

PO BOX 69
HAGERMAN ID
83332-0069
US

V. Phone/Fax

Practice location:
  • Phone: 208-886-0534
  • Fax: 208-278-8439
Mailing address:
  • Phone: 208-886-0534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-16884
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: