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General NPI Number Information
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NPI Number | 1942032776
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Entity Type | Organization
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Legal Business Name | MOSAIC VILLAGE
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 580 E WILLIAMS AVE
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City | HILDALE
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State | UT
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Zip | 84784-7761
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Country | US
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Telephone | 435-619-3028
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3184
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City | COLORADO CITY
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State | AZ
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Zip | 86021-3184
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER MIDDLETON
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Credential | BCBA, LBA
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Telephone | 435-619-3028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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