Healthcare Provider Details

I. General information

NPI: 1881557775
Provider Name (Legal Business Name): KOA BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11917 N 130TH EAST AVE
COLLINSVILLE OK
74021-1103
US

IV. Provider business mailing address

11917 N 130TH E AVE
COLLINSVILLE OK
74021
US

V. Phone/Fax

Practice location:
  • Phone: 808-348-5397
  • Fax:
Mailing address:
  • Phone: 808-348-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALISA KUKA
Title or Position: OWNER
Credential: M.ED, BCBA, LBA
Phone: 808-348-5397