Healthcare Provider Details

I. General information

NPI: 1093656894
Provider Name (Legal Business Name): EXPANDING MINDS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1764 W 4800 S APT J
ROY UT
84067-3640
US

IV. Provider business mailing address

1764 W 4800 S APT J
ROY UT
84067-3640
US

V. Phone/Fax

Practice location:
  • Phone: 435-513-2075
  • Fax:
Mailing address:
  • Phone: 435-513-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MCKENNA MARIE DOUGLAS
Title or Position: OWNER
Credential: BCBA
Phone: 435-513-2075