Provider Demographics
NPI:1770066540
Name:HANKS, JULIE (BCBA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HANKS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 E CASTO LN
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6305
Mailing Address - Country:US
Mailing Address - Phone:801-520-2483
Mailing Address - Fax:
Practice Address - Street 1:2728 E CASTO LN
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-6305
Practice Address - Country:US
Practice Address - Phone:801-520-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10895129-2506103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral