Healthcare Provider Details

I. General information

NPI: 1598660805
Provider Name (Legal Business Name): BRIGHT MOMENTS ABA THERAPY UT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E BROADWAY STE 203-1105
SALT LAKE CITY UT
84111-2227
US

IV. Provider business mailing address

30 E BROADWAY STE 2031105
SALT LAKE CITY UT
84111-2227
US

V. Phone/Fax

Practice location:
  • Phone: 347-902-0468
  • Fax:
Mailing address:
  • Phone: 347-902-0468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEVI EISEN
Title or Position: DIRECTOR
Credential:
Phone: 347-902-0468