Provider Demographics
NPI:1962972489
Name:CHEEVER, MICKELLE (BCBA)
Entity type:Individual
Prefix:
First Name:MICKELLE
Middle Name:
Last Name:CHEEVER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:MICKELLE
Other - Middle Name:
Other - Last Name:CHEEVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1443 W 800 N STE 103
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2878
Mailing Address - Country:US
Mailing Address - Phone:801-655-4950
Mailing Address - Fax:
Practice Address - Street 1:1507 S 180 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5570
Practice Address - Country:US
Practice Address - Phone:801-426-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-21-47396103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician