Healthcare Provider Details

I. General information

NPI: 1922859875
Provider Name (Legal Business Name): AUTISM CELEBRATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N EAST PROMONTORY STE 200
FARMINGTON UT
84025-2950
US

IV. Provider business mailing address

2211 FIELD STONE WAY
LAYTON UT
84041-5532
US

V. Phone/Fax

Practice location:
  • Phone: 801-635-0337
  • Fax:
Mailing address:
  • Phone: 801-635-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRELLA PETERSEN
Title or Position: OWNER / EXECUTIVE DIRECTOR
Credential: DHA, MISM
Phone: 801-635-0337