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General NPI Number Information
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NPI Number | 1063627388
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Entity Type | Organization
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Legal Business Name | BRAIN BEHAVIOR ASSOCIATES, P.C.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 533 26TH ST SUITE 100
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City | OGDEN
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State | UT
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Zip | 84401-2465
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Country | US
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Telephone | 801-621-7320
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Fax | 801-394-0394
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Provider Business Mailing Address
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Address Line | 533 26TH ST SUITE 100
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City | OGDEN
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State | UT
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Zip | 84401-2465
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Country | US
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Telephone | 801-621-7320
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Fax | 801-394-0394
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEVERLY O'CONNOR
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Credential | PH.D.
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Telephone | 801-621-7320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 191411-2501
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License Number State | UT
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