MEDICARE: MIKAELA CARPENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		AZ

General Provider Information

NPI Number	:	1679361570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAELA CARPENTER

Provider Business Mailing Address
First Line	:	2855 E BROWN RD STE 9
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-4215
Country	:	US
Telephone Number	:	480-997-1220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2855 E BROWN RD STE 9
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-4215
Country	:	US
Telephone Number	:	480-997-1220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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Directions to “ MIKAELA CARPENTER ” Practice Location

Language	Start Address	Practice Location

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