MEDICARE: BEEHIVE BEHAVIOR SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1174386064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEEHIVE BEHAVIOR SERVICES LLC

Provider Business Mailing Address
First Line	:	1418 S INDIAN HILLS CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 S INDIAN HILLS CIR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-2410
Country	:	US
Telephone Number	:	385-321-7880
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	JESSE YARGER
Credential	:	BCBA, IBA, LBA
Telephone Number	:	385-321-7880

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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