Provider Demographics
NPI:1740777267
Name:COOMBS, DAVID HALES (MFC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HALES
Last Name:COOMBS
Suffix:
Gender:M
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 W RED BUTTE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8485
Mailing Address - Country:US
Mailing Address - Phone:435-705-3579
Mailing Address - Fax:
Practice Address - Street 1:1296 W RED BUTTE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-8485
Practice Address - Country:US
Practice Address - Phone:435-705-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5039942-3902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health