MEDICARE: MANU BEHAVIORAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1194663039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANU BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	2955 S 1375 W
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9067
Country	:	US
Telephone Number	:	801-580-0152
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 S 1375 W
Second Line	:
City	:	SYRACUSE
State	:	UT
Zip	:	84075-9067
Country	:	US
Telephone Number	:	801-580-0152
Fax Number	:

Authorized Official
Title or Position	:	BCBA/OWNER
Name	:	CALLISSA MANU
Credential	:	M.ED., BCBA, LBA
Telephone Number	:	801-580-0152

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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