Provider Demographics
NPI:1841409158
Name:MUSTARD SEED AUTISM PROJECT, INC
Entity Type:Organization
Organization Name:MUSTARD SEED AUTISM PROJECT, INC
Other - Org Name:ABA ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:817-277-8870
Mailing Address - Street 1:PO BOX 14597
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76094-1597
Mailing Address - Country:US
Mailing Address - Phone:817-277-8870
Mailing Address - Fax:817-277-8875
Practice Address - Street 1:3605 WEST PIONEER PKWY.
Practice Address - Street 2:SUITE C
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-4500
Practice Address - Country:US
Practice Address - Phone:817-277-8870
Practice Address - Fax:817-277-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073398103K00000X
TX1-07-3398251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-16-21569OtherBEHAVIOR ANALYST CERTIFICATION BOARD- BCBA
TX1-07-3398OtherBCBA CERTIFICATION
TX1-15-19081OtherBCBA CERTIFICATION