Provider Demographics
NPI:1336648948
Name:CHUN, TAMRA (M ED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:CHUN
Suffix:
Gender:F
Credentials:M ED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 S 100 E
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2252
Mailing Address - Country:US
Mailing Address - Phone:801-382-9338
Mailing Address - Fax:801-383-0246
Practice Address - Street 1:95 S 100 E
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2252
Practice Address - Country:US
Practice Address - Phone:801-382-9338
Practice Address - Fax:801-383-0246
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
UT11774255-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396085718Medicaid