Healthcare Provider Details

I. General information

NPI: 1144767583
Provider Name (Legal Business Name): MOSAICS ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12632 CALISTOGA WAY
AUSTIN TX
78732-2452
US

IV. Provider business mailing address

2900 N QUINLAN PARK RD SUITE 240/235
AUSTIN TX
78732-6083
US

V. Phone/Fax

Practice location:
  • Phone: 949-295-6599
  • Fax:
Mailing address:
  • Phone: 949-295-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: NISSA VAN ETTEN
Title or Position: DIRECTOR/ OWNER
Credential: M.A., BCBA
Phone: 949-295-6599