Provider Demographics
NPI:1942726237
Name:SILVA, JASON (BCBA, LBA, TRS, CTRS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:SILVA
Suffix:
Gender:M
Credentials:BCBA, LBA, TRS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 N CHURCH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-6616
Mailing Address - Country:US
Mailing Address - Phone:385-213-4625
Mailing Address - Fax:
Practice Address - Street 1:2940 N CHURCH ST STE 204
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6616
Practice Address - Country:US
Practice Address - Phone:385-213-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12383970-2506103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1396085718Medicaid