Provider Demographics
NPI:1336621283
Name:DAVIES, CAROLYN THORNTON GRANT (RBT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:THORNTON GRANT
Last Name:DAVIES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:THORNTON
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:1361 W 1200 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2054
Mailing Address - Country:US
Mailing Address - Phone:727-219-2784
Mailing Address - Fax:
Practice Address - Street 1:935 E 2985 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040
Practice Address - Country:US
Practice Address - Phone:801-771-0273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-18-64748106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician