Healthcare Provider Details

I. General information

NPI: 1396463451
Provider Name (Legal Business Name): MAKAYLA KELLY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 N COLUMBIA ST
MILTON FREEWATER OR
97862-1368
US

IV. Provider business mailing address

305 N HEATHERWILDE BLVD STE 340-350
PFLUGERVILLE TX
78660-3757
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-6207
  • Fax:
Mailing address:
  • Phone: 512-305-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: