Provider Demographics
NPI:1700595196
Name:POSSIBILITIES ABA UTAH LLC
Entity Type:Organization
Organization Name:POSSIBILITIES ABA UTAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-791-4705
Mailing Address - Street 1:3641 VISTA VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5655
Mailing Address - Country:US
Mailing Address - Phone:718-791-4705
Mailing Address - Fax:
Practice Address - Street 1:3641 VISTA VIEW CIR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5655
Practice Address - Country:US
Practice Address - Phone:718-791-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health