Healthcare Provider Details

I. General information

NPI: 1619882453
Provider Name (Legal Business Name): NEUROBEHAVIORAL CENTER FOR GROWTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MEDICAL DR STE A100
BOUNTIFUL UT
84010-4995
US

IV. Provider business mailing address

415 MEDICAL DR STE A100
BOUNTIFUL UT
84010-4995
US

V. Phone/Fax

Practice location:
  • Phone: 801-683-1062
  • Fax:
Mailing address:
  • Phone: 801-683-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JENNA THORKELSON
Title or Position: RBT
Credential:
Phone: 435-236-0227