Healthcare Provider Details

I. General information

NPI: 1770253817
Provider Name (Legal Business Name): PETER CHANDLER BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 WILLOWBROOK DR
RICHFIELD UT
84701-1759
US

IV. Provider business mailing address

345 WILLOWBROOK DR
RICHFIELD UT
84701-1759
US

V. Phone/Fax

Practice location:
  • Phone: 801-349-0616
  • Fax:
Mailing address:
  • Phone: 801-349-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12637538-2506
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: