Individual
MIKKI B COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
160 PLAINFIELD VILLAGE DRIVE, SUITE 101, NULL, PLAINFIELD, IN 46168-2782
(463) 888-0118
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(317) 939-5377
(317) 932-7880
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-43590
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-43590
BACB CERTIFICATION
IN
Enumeration date
08/13/2020
Last updated
08/13/2020
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