NPIMap

Organization Active NPI

Jackson Autism Center

  • Behavior Analyst
  • Jackson, MS
National Provider Identifier
1104166776
Registry record updated Feb 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
JACKSON AUTISM CENTER
Practice address
314 Colonial Cir
Jackson, MS 39211-4213
Phone
(769) 218-9596
NPI assigned
Feb 19, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rebecca Mullican, PHD
Title
Behavior Interventionist
Phone
(769) 218-9596

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary
Community/Behavioral Health Agency 251S00000X
Early Intervention Provider Agency 252Y00000X

Addresses

Primary practice location

314 Colonial Cir
Jackson, MS 39211-4213

Mailing address

314 Colonial Cir
Jackson, MS 39211-4213
Phone (769) 218-9596

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361232000000",
    "number": "1104166776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 COLONIAL CIR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114213",
            "telephone_number": "769-218-9596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 COLONIAL CIR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392114213",
            "telephone_number": "769-218-9596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON AUTISM CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-19",
        "last_updated": "2013-02-19",
        "status": "A",
        "authorized_official_last_name": "MULLICAN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "BEHAVIOR INTERVENTIONIST",
        "authorized_official_telephone_number": "769-218-9596",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.