MEDICARE: MIKAYLA WILLIAMSON

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	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician	RBT-20-136951	TX
3	103K00000X	Behavior Analyst	PSY-BA-LIC-4584	MT

General Provider Information

NPI Number	:	1861090672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA WILLIAMSON

Provider Business Mailing Address
First Line	:	1533 AUSTIN HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1730
Country	:	US
Telephone Number	:	210-748-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 S 25TH ST W STE 2
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-7417
Country	:	US
Telephone Number	:	406-656-0928
Fax Number	:

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

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/20/2023

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Directions to “ MIKAYLA WILLIAMSON ” Practice Location

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