Active NPI
Henry Wallace
- Behavior Technician
- St George, UT
National Provider Identifier
1285381830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1067 E Tabernacle St
St George, UT 84770-3163 - Phone
- (801) 255-5131
- NPI assigned
- Mar 3, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1067 E Tabernacle St
St George, UT 84770-3163
Mailing address
6013 S Redwood Rd
Taylorsville, UT 84123-5220
Phone (801) 255-5131
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104119619 | Other | BEHAVIOR TECH |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | credentialing@utbs.co |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1285381830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6013 S REDWOOD RD",
"city": "TAYLORSVILLE",
"state": "UT",
"postal_code": "841235220",
"telephone_number": "801-255-5131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1067 E TABERNACLE ST",
"city": "ST GEORGE",
"state": "UT",
"postal_code": "847703163",
"telephone_number": "801-255-5131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "HENRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-03",
"last_updated": "2023-05-15",
"certification_date": "2023-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEHAVIOR TECH",
"identifier": "1104119619",
"state": null
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "credentialing@utbs.co",
"affiliation": "N",
"address_1": "1067 E Tabernacle St",
"city": "St George",
"state": "UT",
"country_code": "US",
"postal_code": "847703163",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in St George, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.