Provider Demographics
NPI:1497465165
Name:COLLINS, THEODORE B (CMHC)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:B
Last Name:COLLINS
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 ADAMS AVE PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6955
Mailing Address - Country:US
Mailing Address - Phone:435-764-0824
Mailing Address - Fax:
Practice Address - Street 1:1149 S 450 W STE 208
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-6710
Practice Address - Country:US
Practice Address - Phone:801-392-0942
Practice Address - Fax:801-392-0943
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health