Healthcare Provider Details

I. General information

NPI: 1184019457
Provider Name (Legal Business Name): APPLIED BEHAVIOR CONNECTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 02/08/2016
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: 801-396-2828
Mailing address:
  • Phone: 801-935-5796
  • Fax: 801-396-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1022390
License Number StateUT

VIII. Authorized Official

Name: MARIA CACERES-LOVELESS
Title or Position: CO-FOUNDER/CLINICAL DIRECTOR
Credential: MA BCBA
Phone: 801-935-5796