NPI 1316314081
Ethan Colburn, CMHCI
Practice location
- Address
- 21360 N 1450 E, Moroni, UT 84646-0461
- Phone
- (435) 445-5200
- Fax
- (435) 445-5201
- Mailing address
- PO Box 461 21360 N 1450 E, Moroni, UT 84646-0461
Registered specialties
Substance Abuse Rehabilitation Facility
Primary
Registry record
- NPI
- 1316314081
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 28 Aug 2015
- Record last updated
- 28 Aug 2015
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.