Provider Demographics
NPI:1558071647
Name:ARSHAD, MARLEY BURKINSHAW
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:BURKINSHAW
Last Name:ARSHAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 S 800 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-4505
Mailing Address - Country:US
Mailing Address - Phone:801-785-9019
Mailing Address - Fax:
Practice Address - Street 1:867 S 800 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-4505
Practice Address - Country:US
Practice Address - Phone:801-785-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-22-240698OtherBEHAVIOR ANALYST CERTIFICATION BOARD