Provider Demographics
NPI:1144767583
Name:MOSAICS ABA, LLC
Entity Type:Organization
Organization Name:MOSAICS ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN ETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:949-295-6599
Mailing Address - Street 1:2900 N QUINLAN PARK RD
Mailing Address - Street 2:SUITE 240/235
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-6083
Mailing Address - Country:US
Mailing Address - Phone:949-295-6599
Mailing Address - Fax:
Practice Address - Street 1:12632 CALISTOGA WAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2452
Practice Address - Country:US
Practice Address - Phone:949-295-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty