| Gracious Growth Utah Llc | |
|
50 W Broadway Suite 333 - 999508 Salt Lake City UT 84101 | |
| (917) 771-4207 | |
| Not Available |
| Full Name | Gracious Growth Utah Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 50 W Broadway, Salt Lake City, Utah |
| Authorized Official Name and Position | Avi Marmorstein (CEO) |
| Authorized Official Contact | 9177714207 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gracious Growth Utah Llc 15 Skyline Dr Thiells NY 10984-1427 Ph: () - | Gracious Growth Utah Llc 50 W Broadway Suite 333 - 999508 Salt Lake City UT 84101 Ph: (917) 771-4207 |
| NPI Number | 1710710827 |
|---|---|
| Provider Enumeration Date | 08/23/2024 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710710827 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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