MEDICARE: BIO BEHAVIORAL INTERVENTIONS PC

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	251S00000X	Community/Behavioral Health Agency	137847-3501	UT

General Provider Information

NPI Number	:	1316153364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIO BEHAVIORAL INTERVENTIONS PC

Provider Business Mailing Address
First Line	:	1415 E 2100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3724
Country	:	US
Telephone Number	:	801-474-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 E 2100 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3724
Country	:	US
Telephone Number	:	801-474-2100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. BONNIE SUZE HARRINGTON
Credential	:	LCSW
Telephone Number	:	801-474-2100

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	04/14/2010

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