Provider Demographics
NPI:1083175152
Name:SIMMONS, MICHELLE B (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:B
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6647 W MERLOT WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-5066
Mailing Address - Country:US
Mailing Address - Phone:801-918-7239
Mailing Address - Fax:
Practice Address - Street 1:2940 N CHURCH ST STE 204
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6616
Practice Address - Country:US
Practice Address - Phone:801-823-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-23-68851103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst