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General NPI Number Information
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NPI Number | 1881557775
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Entity Type | Organization
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Legal Business Name | KOA BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 11917 N 130TH EAST AVE
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City | COLLINSVILLE
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State | OK
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Zip | 74021-1103
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Country | US
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Telephone | 808-348-5397
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Fax |
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Provider Business Mailing Address
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Address Line | 11917 N 130TH E AVE
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City | COLLINSVILLE
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State | OK
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Zip | 74021
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Country | US
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Telephone | 808-348-5397
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALISA KUKA
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Credential | M.ED, BCBA, LBA
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Telephone | 808-348-5397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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