Healthcare Provider Details

I. General information

NPI: 1508770330
Provider Name (Legal Business Name): BEDROCK BEHAVIOR CHANGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 SPANISH VALLEY DR UNIT E3
MOAB UT
84532-3644
US

IV. Provider business mailing address

3686 SPANISH VALLEY DR UNIT E3
MOAB UT
84532-3644
US

V. Phone/Fax

Practice location:
  • Phone: 845-325-7593
  • Fax:
Mailing address:
  • Phone: 845-325-7593
  • 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: MS. LINDSAY NICOLE TRUDEAU
Title or Position: OWNER
Credential: M.ED BCBA
Phone: 845-325-7593