Provider Demographics
NPI:1720401342
Name:MOMENTUM ABA LLC
Entity Type:Organization
Organization Name:MOMENTUM ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS, BCABA
Authorized Official - Phone:832-454-4845
Mailing Address - Street 1:12310 N SHADOW COVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2504
Mailing Address - Country:US
Mailing Address - Phone:832-454-4845
Mailing Address - Fax:
Practice Address - Street 1:12310 N SHADOW COVE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2504
Practice Address - Country:US
Practice Address - Phone:832-454-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization