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NPI Code Detail

MEDICARE: KOA BEHAVIORAL HEALTH LLC

MEDICARE: KOA BEHAVIORAL HEALTH LLC
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1881557775
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOA BEHAVIORAL HEALTH LLC
Provider Business Mailing Address
First Line : 11917 N 130TH E AVE
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021
Country : US
Telephone Number : 808-348-5397
Fax Number :
Provider Business Practice Location Address
First Line : 11917 N 130TH EAST AVE
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-1103
Country : US
Telephone Number : 808-348-5397
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. ALISA KUKA
Credential : M.ED, BCBA, LBA
Telephone Number : 808-348-5397
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “KOA BEHAVIORAL HEALTH LLC ” Practice Location

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