Provider Demographics
NPI:1699194779
Name:MATHISEN, DAVID (BCBA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MATHISEN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 SPEEDWAY APT 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2828
Mailing Address - Country:US
Mailing Address - Phone:205-401-0884
Mailing Address - Fax:
Practice Address - Street 1:3107 SPEEDWAY APT 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2828
Practice Address - Country:US
Practice Address - Phone:205-401-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst