ETHAN COLBURN CMHCI NPI 1316314081

NPI Information

NPI: 1316314081
Provider Name: ETHAN COLBURN, CMHCI
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Individual
Address:
21360 N 1450 E
MORONI, UT
ZIP 84646
Phone: (435) 445-5200
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Ethan Colburn, CMHCI is a substance abuse rehabilitation facility in Moroni, UT. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. Ethan Colburn, CMHCI NPI is 1316314081. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

21360 N 1450 E
MORONI, UT
ZIP 84646-461
Phone: (435) 445-5200
Fax: (435) 445-5201

The enumeration date for this NPI number is 8/28/2015 and was last updated on 8/28/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	324500000X	Substance Abuse Rehabilitation Facility			UTAH	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	272503815	MEDICAID	UTAH

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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