Provider Demographics
NPI:1023624103
Name:DYSON, MIKAYLA (BCBA)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:DYSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 BUCK CHERRY WAY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-8261
Mailing Address - Country:US
Mailing Address - Phone:615-525-0435
Mailing Address - Fax:
Practice Address - Street 1:608 BUCK CHERRY WAY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-8261
Practice Address - Country:US
Practice Address - Phone:615-525-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician