Provider Demographics
NPI:1700438108
Name:BINGHAM, DANIELLE COLLEEN (DB)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:COLLEEN
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:DB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2985 N 935 E STE 7
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-7318
Mailing Address - Country:US
Mailing Address - Phone:855-223-7123
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:404 E 4500 S STE A34
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2710
Practice Address - Country:US
Practice Address - Phone:801-771-0273
Practice Address - Fax:801-771-0221
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician