Healthcare Provider Details

I. General information

NPI: 1861152951
Provider Name (Legal Business Name): KYLE JAY MOKMA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PINECREST ST
ALPENA MI
49707-1328
US

IV. Provider business mailing address

2805 S INDUSTRIAL HWY STE 100
ANN ARBOR MI
48104-6791
US

V. Phone/Fax

Practice location:
  • Phone: 989-278-8878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: