Provider Demographics
NPI:1922859875
Name:AUTISM CELEBRATIONS, LLC
Entity Type:Organization
Organization Name:AUTISM CELEBRATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DHA, MISM
Authorized Official - Phone:801-635-0337
Mailing Address - Street 1:2211 FIELD STONE WAY
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5532
Mailing Address - Country:US
Mailing Address - Phone:801-635-0337
Mailing Address - Fax:
Practice Address - Street 1:240 N EAST PROMONTORY STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2950
Practice Address - Country:US
Practice Address - Phone:801-635-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty