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Individual

MISS MIKALA RAE HANSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSY.D.; BCBA-D

Contact information

Practice address
230 S NOLEN DR BLDG 3, SOUTHLAKE, TX 76092-8078
(817) 402-8250
Mailing address
804 ABERDEEN WAY, SOUTHLAKE, TX 76092-9559
(813) 471-8721

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-17-25337
103T00000X
Psychologist
Primary
103TC0700X
Clinical Psychologist
06416
MD
103TC0700X
Clinical Psychologist
38644
TX
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
05/13/2019
Last updated
03/23/2023
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