Healthcare Provider Details

I. General information

NPI: 1285151696
Provider Name (Legal Business Name): ERIN GATES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 11/27/2023
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 E FORT UNION BLVD
SALT LAKE CITY UT
84121-2847
US

IV. Provider business mailing address

8209 N CEDAR SPRINGS RD
EAGLE MOUNTAIN UT
84005-2644
US

V. Phone/Fax

Practice location:
  • Phone: 801-641-4675
  • Fax:
Mailing address:
  • Phone: 801-641-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11499178-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: