Healthcare Provider Details

I. General information

NPI: 1982193801
Provider Name (Legal Business Name): ELIZABETH MUTZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 10/06/2021
Certification Date: 09/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 VIRGINIA PKWY STE 105
MCKINNEY TX
75071-5411
US

IV. Provider business mailing address

5801 VIRGINIA PKWY STE 105
MCKINNEY TX
75071-5411
US

V. Phone/Fax

Practice location:
  • Phone: 469-284-0801
  • Fax: 903-630-6172
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49740
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-53999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: