Provider Demographics
NPI:1306460803
Name:VAN ARSDALE, MIKAYLA LABRILLAZO (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:LABRILLAZO
Last Name:VAN ARSDALE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E NORTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2420
Mailing Address - Country:US
Mailing Address - Phone:317-699-4281
Mailing Address - Fax:
Practice Address - Street 1:321 E NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2420
Practice Address - Country:US
Practice Address - Phone:317-699-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-23-68815103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty