Provider Demographics
NPI:1982190252
Name:MUT, ARIEL JANAYE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:JANAYE
Last Name:MUT
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:JANAYE
Other - Last Name:TENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 W EASTMAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5948
Mailing Address - Country:US
Mailing Address - Phone:847-873-1505
Mailing Address - Fax:947-221-8285
Practice Address - Street 1:120 W EASTMAN ST STE 102
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5948
Practice Address - Country:US
Practice Address - Phone:847-873-1505
Practice Address - Fax:847-221-8285
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-18-30797103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst