MEDICARE: MIKAILA KOPSKY BCBA, LBA

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	12370087	MO

General Provider Information

NPI Number	:	1992516199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAILA KOPSKY BCBA, LBA

Provider Business Mailing Address
First Line	:	1919 BASIL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-2508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3880 SHADY SPRINGS LN
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-4126
Country	:	US
Telephone Number	:	636-493-1344
Fax Number	:	636-534-1453

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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