Healthcare Provider Details

I. General information

NPI: 1205584778
Provider Name (Legal Business Name): MAXIMILLIAN ANDREWS BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 FASHION POINT DR STE 100
SOUTH OGDEN UT
84403-4848
US

IV. Provider business mailing address

1105 W RUSSELL ST
SIOUX FALLS SD
57104-1322
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-2690
  • Fax:
Mailing address:
  • Phone: 605-271-2690
  • Fax: 605-271-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-75755
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: