NPI 1902293939 · live from the CMS NPI Registry
Autism Assessment Treatment Program Child
Behavior Analyst in Salt Lake City, UT. National Provider Identifier 1902293939, active.
NPI record
| NPI | 1902293939 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 650 S Komas Dr, Suite 206, Salt Lake City, UT 84108 |
| Practice phone | 801-581-8110 |
| Enumerated | April 16, 2015 |
| Last updated | May 1, 2015 |
| Authorized official | Kim Treadway, Billing Specialist |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Cognitive & Behavioral | 103TB0200X | — |
| Social Worker, Clinical | 1041C0700X | — |
| Behavior Analyst primary | 103K00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.