Basic Information
| Provider Information | |||||||||
| NPI: | 1760931281 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWINNEA | ||||||||
| FirstName: | MIKEALA | ||||||||
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| Credential: | BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3006 BEE CAVES RD | ||||||||
| Address2: | SUITE B200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123285599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5804 BOAT CLUB ROAD | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173108792 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2016 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.