Provider Demographics
NPI:1245711167
Name:GATES, REBECCA DANIELLE (BCABA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DANIELLE
Last Name:GATES
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DANIELLE
Other - Last Name:TRIBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 E GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 E GORDON AVE
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2341
Practice Address - Country:US
Practice Address - Phone:801-317-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-18-56799106S00000X
UT12165040-2507106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician