Provider Demographics
NPI:1376284364
Name:MOSBURG, JAKE N (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:N
Last Name:MOSBURG
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11915 STONEHOLLOW DR APT 1126B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3112
Mailing Address - Country:US
Mailing Address - Phone:785-313-2518
Mailing Address - Fax:
Practice Address - Street 1:2100 KRAMER LN STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4094
Practice Address - Country:US
Practice Address - Phone:512-572-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst