Basic Information
| Provider Information | |||||||||
| NPI: | 1457893141 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UTAH BEHAVIOR SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 627 E 4400 S | ||||||||
| Address2: | UNIT A | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012555131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5202 FREEWAY PARK DR | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844054016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012555131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2016 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | TUELLER | ||||||||
| AuthorizedOfficialFirstName: | DALLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8012555131 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA/SSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 193200000X MULTI-SPECIALTY GROUP |
No ID Information.