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NPI Code Detail

MEDICARE: ERIN GATES BCBA

MEDICARE: ERIN GATES BCBA
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
1106S00000XBehavior Technician
2103K00000XBehavior Analyst11499178-2506UT

General Provider Information

NPI Number : 1285151696
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN GATES BCBA
Provider Business Mailing Address
First Line : 8209 N CEDAR SPRINGS RD
Second Line :
City : EAGLE MOUNTAIN
State : UT
Zip : 84005-2644
Country : US
Telephone Number : 801-641-4675
Fax Number :
Provider Business Practice Location Address
First Line : 1441 E FORT UNION BLVD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-2847
Country : US
Telephone Number : 801-641-4675
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2017
Last Update Date : 11/27/2023

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