Provider Demographics
NPI:1629748686
Name:PBJF
Entity Type:Organization
Organization Name:PBJF
Other - Org Name:PBJ & FRIENDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-472-4606
Mailing Address - Street 1:3857 E HOLLOW CREST DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6277
Mailing Address - Country:US
Mailing Address - Phone:801-472-4606
Mailing Address - Fax:
Practice Address - Street 1:1238 N COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-4713
Practice Address - Country:US
Practice Address - Phone:801-472-4606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty