Healthcare Provider Details

I. General information

NPI: 1518668979
Provider Name (Legal Business Name): PRECISION LEARNING & BEHAVIORAL CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 W 100 N
VERNAL UT
84078-2042
US

IV. Provider business mailing address

HC 67 BOX 31
TRIDELL UT
84076-9703
US

V. Phone/Fax

Practice location:
  • Phone: 435-790-4270
  • Fax:
Mailing address:
  • Phone: 435-219-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE O'DRISCOLL
Title or Position: OWNER
Credential: BCBA
Phone: 435-790-4270