Provider Demographics
NPI:1689191207
Name:THOMAS, MARAH GOLDING (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MARAH
Middle Name:GOLDING
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 S 400 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-4861
Mailing Address - Country:US
Mailing Address - Phone:385-445-3786
Mailing Address - Fax:
Practice Address - Street 1:345 N STATE ROAD 198
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653-5719
Practice Address - Country:US
Practice Address - Phone:801-423-3000
Practice Address - Fax:801-423-3844
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
UT11788234-2506103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician