Provider Demographics
NPI:1659179943
Name:REID, BENJAMIN TODD (RBT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TODD
Last Name:REID
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 W 110 N APT 102
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3459
Mailing Address - Country:US
Mailing Address - Phone:405-531-8773
Mailing Address - Fax:
Practice Address - Street 1:1249 W 110 N APT 102
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3459
Practice Address - Country:US
Practice Address - Phone:385-354-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-25-405985103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities