Healthcare Provider Details

I. General information

NPI: 1285170712
Provider Name (Legal Business Name): MRS. TRISHA HOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 01/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5160 SUNSET LN
SOUTH OGDEN UT
84403-4230
US

IV. Provider business mailing address

5160 SUNSET LN
SOUTH OGDEN UT
84403-4230
US

V. Phone/Fax

Practice location:
  • Phone: 801-935-5796
  • Fax:
Mailing address:
  • Phone: 801-935-5796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB340632
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: