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NPI Code Detail

MEDICARE: IBEHAVE THERAPY GROUP LLC.

MEDICARE: IBEHAVE THERAPY GROUP 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1578983318
Entity Type Code : Organization
Provider Name (Legal Business Name) : IBEHAVE THERAPY GROUP LLC.
Provider Business Mailing Address
First Line : 2985 N 935 E STE 7
Second Line :
City : LAYTON
State : UT
Zip : 84040-7318
Country : US
Telephone Number : 801-771-0273
Fax Number :
Provider Business Practice Location Address
First Line : 2985 N 935 E STE 7
Second Line :
City : LAYTON
State : UT
Zip : 84040-7318
Country : US
Telephone Number : 801-771-0273
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : NICOLE NORDELLO
Credential : MA, BCBA
Telephone Number : 801-564-2794
Provider Enumeration Date : 04/20/2014
Last Update Date : 07/29/2020

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Directions to “IBEHAVE THERAPY GROUP LLC. ” Practice Location

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