Active NPI
Gentrey Erickson
- Behavior Analyst
- Draper, UT
National Provider Identifier
1184209546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 12637 S 265 W Ste 300
Draper, UT 84020-5403 - Phone
- (801) 998-8428
- NPI assigned
- Mar 16, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assistant Behavior Analyst | 106E00000X | BACB442682 | UT | |
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
12637 S 265 W Ste 300
Draper, UT 84020-5403
Mailing address
12637 S 265 W Ste 300
Draper, UT 84020-5403
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB442682 | UT | MD | Assistant Behavior Analyst |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Autism & Behavioral Intervention, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- Draper, UT
- NPI 1144610502
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690416000000",
"number": "1184209546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12637 S 265 W STE 300",
"city": "DRAPER",
"state": "UT",
"postal_code": "840205403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12637 S 265 W STE 300",
"city": "DRAPER",
"state": "UT",
"postal_code": "840205403",
"telephone_number": "801-998-8428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERICKSON",
"first_name": "GENTREY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-16",
"last_updated": "2023-07-27",
"certification_date": "2023-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "106E00000X",
"taxonomy_group": "",
"desc": "Assistant Behavior Analyst",
"state": "UT",
"license": "BACB442682",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.