Healthcare Provider Details

I. General information

NPI: 1083362255
Provider Name (Legal Business Name): MYKAELA ALEYA LA FUENTE BS, BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GENESIS BLVD STE D
WEBSTER TX
77598-1664
US

IV. Provider business mailing address

614 FOREST BEND LN
LA MARQUE TX
77568-1598
US

V. Phone/Fax

Practice location:
  • Phone: 832-569-4316
  • Fax:
Mailing address:
  • Phone: 409-370-4262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberBHV-010752
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: