Provider Demographics
NPI:1720643778
Name:ALAN TRIBBLE BEHAVIOR ANALYST LLC
Entity Type:Organization
Organization Name:ALAN TRIBBLE BEHAVIOR ANALYST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-696-7319
Mailing Address - Street 1:3274 E OAKCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-5660
Mailing Address - Country:US
Mailing Address - Phone:801-696-7319
Mailing Address - Fax:
Practice Address - Street 1:3274 E OAKCLIFF DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-5660
Practice Address - Country:US
Practice Address - Phone:801-696-7319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1225426786Medicaid