Provider Demographics
NPI:1790214120
Name:INTEGRATED AUTISM THERAPIES
Entity Type:Organization
Organization Name:INTEGRATED AUTISM THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIEDERHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-913-9963
Mailing Address - Street 1:5984 S SUSQUEHANNA
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5527
Mailing Address - Country:US
Mailing Address - Phone:801-243-5868
Mailing Address - Fax:
Practice Address - Street 1:5984 S. SUSQUEHANNA
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123
Practice Address - Country:US
Practice Address - Phone:801-243-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty