Colton Blackham
NPI 1073809984 · on the registry since 2011 · sole proprietor
Practice
- Address
- 21260 N 1450 E
Moroni, UT 84646 - Phone
- (435) 445-5200
- Fax
- (435) 445-5201
- Organisation at this address
- Trevor Hansen
Skyline Treatment
Lighthouse Academy LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 36
Registry record
- Primary taxonomy
- Counselor
101Y00000X
- Licence states on file
- UT
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2011-06-20
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Utah