Provider Demographics
NPI:1376144022
Name:BALANCE IN BEHAVIOR
Entity Type:Organization
Organization Name:BALANCE IN BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:801-897-5604
Mailing Address - Street 1:283 E 300 S
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-2258
Mailing Address - Country:US
Mailing Address - Phone:801-897-5604
Mailing Address - Fax:
Practice Address - Street 1:283 E 300 S
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2258
Practice Address - Country:US
Practice Address - Phone:801-897-5604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty