Provider Demographics
NPI:1225406051
Name:BX REDIRECT
Entity Type:Organization
Organization Name:BX REDIRECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDRA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:PIPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:801-923-8773
Mailing Address - Street 1:7456 S 1740 E
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6636
Mailing Address - Country:US
Mailing Address - Phone:801-923-8773
Mailing Address - Fax:
Practice Address - Street 1:7456 S 1740 E
Practice Address - Street 2:
Practice Address - City:SOUTH WEBER
Practice Address - State:UT
Practice Address - Zip Code:84405-6636
Practice Address - Country:US
Practice Address - Phone:801-923-8773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty