Provider Demographics
NPI:1093435133
Name:TRANSITIONAL BEHAVIOR SUPPORT
Entity Type:Organization
Organization Name:TRANSITIONAL BEHAVIOR SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LILINO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA LBA
Authorized Official - Phone:385-245-2555
Mailing Address - Street 1:262 E 1600 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2748
Mailing Address - Country:US
Mailing Address - Phone:385-208-0538
Mailing Address - Fax:
Practice Address - Street 1:262 E 1600 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2748
Practice Address - Country:US
Practice Address - Phone:385-208-0538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1457748923Medicaid