Provider Demographics
NPI:1114471711
Name:CHARLTON, CADE (RBT)
Entity Type:Individual
Prefix:
First Name:CADE
Middle Name:
Last Name:CHARLTON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W 800 N
Mailing Address - Street 2:#103
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2875
Mailing Address - Country:US
Mailing Address - Phone:801-655-4950
Mailing Address - Fax:
Practice Address - Street 1:1507 S 180 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5570
Practice Address - Country:US
Practice Address - Phone:801-426-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst