Healthcare Provider Details

I. General information

NPI: 1780598201
Provider Name (Legal Business Name): BE THE MIRACLE BEHAVIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 E LONE TREE PKWY
EAGLE MOUNTAIN UT
84005-4938
US

IV. Provider business mailing address

2132 E LONE TREE PKWY
EAGLE MOUNTAIN UT
84005-4938
US

V. Phone/Fax

Practice location:
  • Phone: 385-202-9697
  • Fax:
Mailing address:
  • Phone: 385-202-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DARREN G PAIN
Title or Position: OWNER
Credential: BCABA
Phone: 385-202-9697