Healthcare Provider Details

I. General information

NPI: 1699420174
Provider Name (Legal Business Name): AGAPE ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

868 WEST 200 SOUTH STREET B107
AMERICAN FORK UT
84003-8400
US

IV. Provider business mailing address

868 WEST 200 SOUTH STREET B107
AMERICAN FORK UT
84003-8567
US

V. Phone/Fax

Practice location:
  • Phone: 385-230-1684
  • Fax:
Mailing address:
  • Phone: 385-230-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: OLIVIA MYERS
Title or Position: OWNER, CEO
Credential: M.A.
Phone: 385-230-1684