Provider Demographics
NPI:1144599101
Name:PRISBREY, COLLIN KIP
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:KIP
Last Name:PRISBREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:MORONI
Mailing Address - State:UT
Mailing Address - Zip Code:84646-0028
Mailing Address - Country:US
Mailing Address - Phone:435-436-5321
Mailing Address - Fax:435-436-5322
Practice Address - Street 1:4800 EAST 17160 NORTH
Practice Address - Street 2:
Practice Address - City:MORONI
Practice Address - State:UT
Practice Address - Zip Code:84646-0028
Practice Address - Country:US
Practice Address - Phone:435-436-5321
Practice Address - Fax:435-436-5322
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor