Active NPI
Mutina Johnston
- Behavior Analyst
- Tampa, FL
National Provider Identifier
1891382743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-22-60486
- Practice address
- 1202 Tech Blvd Ste 104
Tampa, FL 33619-7863 - Phone
- (813) 592-7686
- NPI assigned
- Dec 27, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | 1-22-60486 | FL | Primary |
Addresses
Primary practice location
1202 Tech Blvd Ste 104
Tampa, FL 33619-7863
Mailing address
1202 Tech Blvd Ste 103
Tampa, FL 33619-7863
Phone (813) 592-7686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Junior Boom ABA LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Brooklyn, NY
- NPI 1861194490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660089600000",
"number": "1891382743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1202 TECH BLVD STE 103",
"city": "TAMPA",
"state": "FL",
"postal_code": "336197863",
"telephone_number": "813-592-7686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 TECH BLVD STE 104",
"city": "TAMPA",
"state": "FL",
"postal_code": "336197863",
"telephone_number": "813-592-7686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "MUTINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-27",
"last_updated": "2022-08-10",
"certification_date": "2022-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "FL",
"license": "1-22-60486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.