Healthcare Provider Details

I. General information

NPI: 1801283833
Provider Name (Legal Business Name): AUTISM ASSEMENT TREATMENT PROGRAM ADULT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S KOMAS SUITE 200
SALT LAKE CITY UT
84108
US

IV. Provider business mailing address

650 S KOMAS SUITE 200
SALT LAKE CITY UT
84108
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-8110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM TREADWAY
Title or Position: BILLING SPECIALIST
Credential:
Phone: 801-581-8110