Healthcare Provider Details

I. General information

NPI: 1245711167
Provider Name (Legal Business Name): REBECCA DANIELLE GATES BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA DANIELLE TRIBE

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E GORDON AVE
LAYTON UT
84041-2341
US

IV. Provider business mailing address

209 E GORDON AVE
LAYTON UT
84041-2341
US

V. Phone/Fax

Practice location:
  • Phone: 801-317-4367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number12165040-2507
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-56799
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: