Provider Demographics
NPI:1215766324
Name:ADAMS, ANDREW (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 GROVE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-1722
Mailing Address - Country:US
Mailing Address - Phone:801-834-8306
Mailing Address - Fax:
Practice Address - Street 1:940 S 2000 W STE 214
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-3197
Practice Address - Country:US
Practice Address - Phone:801-888-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9515472-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst