Provider Demographics
NPI:1174037154
Name:ULASZEK BENJAMIN, MINA NICOLLE (BCBA)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:NICOLLE
Last Name:ULASZEK BENJAMIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 HIGHWAY 16 N
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-3548
Mailing Address - Country:US
Mailing Address - Phone:210-861-4866
Mailing Address - Fax:
Practice Address - Street 1:2500 W WILLIAM CANNON DR # 704
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5257
Practice Address - Country:US
Practice Address - Phone:512-887-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-26090103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst