Provider Demographics
NPI:1083432066
Name:METTLER, SAMSON ASHER (BCBA)
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:ASHER
Last Name:METTLER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 MAN CAVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8759
Mailing Address - Country:US
Mailing Address - Phone:605-370-1293
Mailing Address - Fax:
Practice Address - Street 1:1507 E 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8717
Practice Address - Country:US
Practice Address - Phone:605-906-2758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD125-ABA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst