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General NPI Number Information
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NPI Number | 1659179943
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Entity Type | Individual
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Provider Name | BENJAMIN TODD REID RBT
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Gender | Male
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 1249 W 110 N APT 102
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3459
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Country | US
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Telephone | 385-354-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 1249 W 110 N APT 102
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3459
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Country | US
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Telephone | 405-531-8773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | RBT-25-405985
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License Number State | UT
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