Provider Demographics
NPI:1811223803
Name:AUTISM BEHAVIOR TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:AUTISM BEHAVIOR TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTING CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-572-5727
Mailing Address - Street 1:12222 S 1000 E
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8278
Mailing Address - Country:US
Mailing Address - Phone:801-572-5727
Mailing Address - Fax:801-572-5758
Practice Address - Street 1:12222 S 1000 E
Practice Address - Street 2:SUITE 3
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8278
Practice Address - Country:US
Practice Address - Phone:801-572-5727
Practice Address - Fax:801-572-5758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15914251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services