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General NPI Number Information
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NPI Number | 1841409158
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Entity Type | Organization
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Legal Business Name | MUSTARD SEED AUTISM PROJECT, INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 3605 WEST PIONEER PKWY. SUITE C
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City | ARLINGTON
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State | TX
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Zip | 76013-4500
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Country | US
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Telephone | 817-277-8870
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Fax | 817-277-8875
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Provider Business Mailing Address
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Address Line | PO BOX 14597
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City | ARLINGTON
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State | TX
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Zip | 76094-1597
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Country | US
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Telephone | 817-277-8870
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Fax | 817-277-8875
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. NANCY WAGNER
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Credential | BCBA
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Telephone | 817-277-8870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-07-3398
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1073398
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License Number State | TX
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