Healthcare Provider Details

I. General information

NPI: 1336648948
Provider Name (Legal Business Name): TAMRA CHUN M ED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S 100 E
PAYSON UT
84651-2252
US

IV. Provider business mailing address

95 S 100 E
PAYSON UT
84651-2252
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-9338
  • Fax: 801-383-0246
Mailing address:
  • Phone: 801-382-9338
  • Fax: 801-383-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11774255-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: