Individual
MIKAYLA ALEXANDRA CAMACHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
429 S MAIN ST, LOGAN, UT 84321-5207
(801) 683-1062
Mailing address
1188 N 230 W, LOGAN, UT 84341-2255
(678) 637-5589
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-75956
UT
106S00000X
Behavior Technician
RBT-24-352746
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236
—
DC
01
—
568946544
BCBS
—
01
—
5874
HEALTH PARTNERS
—
Enumeration date
08/20/2021
Last updated
09/27/2024
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