Healthcare Provider Details

I. General information

NPI: 1013417716
Provider Name (Legal Business Name): NATHANIEL MULLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58060 PLAQUEMINE ST
PLAQUEMINE LA
70764-2731
US

IV. Provider business mailing address

184 HIGH ST STE 701
BOSTON MA
02110-3025
US

V. Phone/Fax

Practice location:
  • Phone: 225-687-4341
  • Fax:
Mailing address:
  • Phone: 186-660-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-555
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberC-079
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: