Active NPI
Mikaela C Nicholls
- Behavior Technician
- Bend, OR
National Provider Identifier
1093436925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- ABA-IN-10225094
- Practice address
- 19800 Village Office CT Ste 104
Bend, OR 97702-1813 - Phone
- (541) 306-3483
- Fax
- (541) 639-8909
- NPI assigned
- Sep 8, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | ABA-IN-10225094 | OR | Primary |
Addresses
Primary practice location
19800 Village Office CT Ste 104
Bend, OR 97702-1813
Mailing address
19800 Village Office CT Ste 104
Bend, OR 97702-1813
Phone (541) 306-3483
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ABA-IN-10225094 | OR | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cascade Behavioral Intervention, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662595200000",
"number": "1093436925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19800 VILLAGE OFFICE CT STE 104",
"city": "BEND",
"state": "OR",
"postal_code": "977021813",
"telephone_number": "541-306-3483",
"fax_number": "541-639-8909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19800 VILLAGE OFFICE CT STE 104",
"city": "BEND",
"state": "OR",
"postal_code": "977021813",
"telephone_number": "541-306-3483",
"fax_number": "541-639-8909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLLS",
"first_name": "MIKAELA",
"middle_name": "C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-08",
"last_updated": "2022-09-08",
"certification_date": "2022-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "OR",
"license": "ABA-IN-10225094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
- Nexphase Telehealth, LLC
- Next Step Up Corp (Coney Island Homecare Home Health Oregon)
- Next Step Up Corp (Coney Island Homecare Oregon)
- Next Step Up Corp (Coney Island Homecare Hospice Oregon)
- Patricia Ann Nibler, M.D.
- Claire Therese Nichols, MA, NCC, LPC-INTERN
- Krystin Nichols
- Debra E Nicholson, RN
- Carly Jane Nicolau
- Cheyenne Nieblas-Herrera, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.