Healthcare Provider Details

I. General information

NPI: 1972178481
Provider Name (Legal Business Name): DORIE BEACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6232 S 900 E
MURRAY UT
84121-2471
US

IV. Provider business mailing address

3725 W 4100 S STE 201
SALT LAKE CITY UT
84120-6490
US

V. Phone/Fax

Practice location:
  • Phone: 888-949-4864
  • Fax:
Mailing address:
  • Phone: 888-949-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-226694
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: