Healthcare Provider Details

I. General information

NPI: 1477490704
Provider Name (Legal Business Name): SHARON ALEXOUS MARCUM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON ALEXOUS MOOSMAN BCBA

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W 500 S
PRICE UT
84501-3225
US

IV. Provider business mailing address

80 W 500 S
PRICE UT
84501-3225
US

V. Phone/Fax

Practice location:
  • Phone: 435-650-5826
  • Fax:
Mailing address:
  • Phone: 435-650-5826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88161
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: