Active NPI
Brandon Henshaw
- Behavior Analyst
- Bountiful, UT
National Provider Identifier
1366928152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 415 Medical Dr Ste D101
Bountiful, UT 84010-8905 - Phone
- (801) 683-1062
- NPI assigned
- Jul 14, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
415 Medical Dr Ste D101
Bountiful, UT 84010-8905
Mailing address
415 Medical Dr Ste D101
Bountiful, UT 84010-8905
Phone (801) 683-1062
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366928152 | Medicaid | UT |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | brandon.henshaw@neurobcg.com | Direct |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neurobehavioral Center for Growth LLC | 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.
-
- Psychologist
- Bountiful, UT
- NPI 1942641931
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604448000000",
"number": "1366928152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 MEDICAL DR STE D101",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840108905",
"telephone_number": "801-683-1062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 MEDICAL DR STE D101",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840108905",
"telephone_number": "801-683-1062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENSHAW",
"first_name": "BRANDON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-14",
"last_updated": "2020-11-04",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1366928152",
"state": "UT"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "brandon.henshaw@neurobcg.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "415 Medical Dr Ste D101",
"city": "Bountiful",
"state": "UT",
"country_code": "US",
"postal_code": "840108905",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.