Provider Demographics
NPI:1073790655
Name:COLBREN MANAGEMENT LLC
Entity Type:Organization
Organization Name:COLBREN MANAGEMENT LLC
Other - Org Name:COLBREN FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEMILLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-656-4515
Mailing Address - Street 1:1071 E 100 S
Mailing Address - Street 2:SUITE D3S
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3070
Mailing Address - Country:US
Mailing Address - Phone:435-656-4515
Mailing Address - Fax:435-673-9178
Practice Address - Street 1:1071 E 100 S
Practice Address - Street 2:SUITE D3S
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3070
Practice Address - Country:US
Practice Address - Phone:435-656-4515
Practice Address - Fax:435-673-9178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13428251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health