Provider Demographics
NPI:1568268928
Name:SEALS, MYRA LASHA (RBT)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:LASHA
Last Name:SEALS
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114-4401
Mailing Address - Country:US
Mailing Address - Phone:901-240-2841
Mailing Address - Fax:
Practice Address - Street 1:3239 PLAYERS CLUB PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8845
Practice Address - Country:US
Practice Address - Phone:901-256-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-24-324666106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician