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General NPI Number Information
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NPI Number | 1932765559
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Entity Type | Individual
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Provider Name | MIKAILAH SMITH
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Gender | Female
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 7330 FERN AVE STE 1103
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City | SHREVEPORT
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State | LA
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Zip | 71105-4989
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Country | US
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Telephone | 318-606-5706
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 DOVE HOLLOW DR
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City | SHREVEPORT
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State | LA
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Zip | 71118-5211
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Country | US
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Telephone | 318-461-5294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | L-1003
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License Number State | LA
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