Provider Demographics
NPI:1285435974
Name:CYPRESS, MIKAYLA SADE'
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:SADE'
Last Name:CYPRESS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MORRIS TOWN CIR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:VA
Mailing Address - Zip Code:23950-2054
Mailing Address - Country:US
Mailing Address - Phone:434-233-2142
Mailing Address - Fax:
Practice Address - Street 1:2291 FAIRVIEW RD APT 19
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944-2513
Practice Address - Country:US
Practice Address - Phone:434-233-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health