Basic Information
| Provider Information | |||||||||
| NPI: | 1023522299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLISLE | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 N COMMERCE DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840455309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3855577603 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1305 N COMMERCE DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840455309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3855577603 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2017 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 12932889-2506 | UT | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | N | 175T00000X | N |
No ID Information.