Colburn, Ethan
Colburn, Ethan is an sole proprietor health care provider with primary practice located at 21360 N 1450 E , Moroni UT 84646-0461. He recently has only one registered license in Residential Treatment Facilities / Substance Abuse Rehabilitation Facility, which is considered as his primary health care specialty. Colburn, Ethan can be contacted via phone (435) 445-5200.Contact Information
Primary practice address
21360 N 1450 E
Moroni UT 84646-0461
Phone: (435) 445-5200
Fax: (435) 445-5201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Residential Treatment Facilities / Substance Abuse Rehabilitation Facility | 324500000X | Utah |
Profile Details
| NPI number | 1316314081 |
|---|---|
| LBN Legal business name | Colburn, Ethan |
| Credentials | CMHCI |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 28th, 2015 |
| Last updated | Aug 28th, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316314081 | NPPES |
| Utah | MEDICAID | 272503815 |
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