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NPI Code Detail

MEDICARE: MS. JAZMIN LASHA MULLEN BCBA

MEDICARE: MS. JAZMIN LASHA MULLEN BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-18-30446GA

General Provider Information

NPI Number : 1922584101
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JAZMIN LASHA MULLEN BCBA
Provider Business Mailing Address
First Line : 4250 ROXY CT
Second Line :
City : SNELLVILLE
State : GA
Zip : 30039-2757
Country : US
Telephone Number : 404-345-4863
Fax Number :
Provider Business Practice Location Address
First Line : 1215 HIGHTOWER TRL BLDG B
Second Line :
City : ATLANTA
State : GA
Zip : 30350-6244
Country : US
Telephone Number : 866-750-5554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2018
Last Update Date : 07/11/2018

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