Provider Demographics
NPI:1083461925
Name:UTAH APPLIED BEHAVIOR ANALYSIS
Entity type:Organization
Organization Name:UTAH APPLIED BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-787-3882
Mailing Address - Street 1:223 W COUGAR BLVD STE 412
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79 N MAPLE LEAF DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-6145
Practice Address - Country:US
Practice Address - Phone:619-787-3882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty