Provider Demographics
NPI:1033944004
Name:COLD WHITE FIRE L3C
Entity type:Organization
Organization Name:COLD WHITE FIRE L3C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CREATIVE/ART DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-400-0513
Mailing Address - Street 1:HC 13 BOX 3074
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:UT
Mailing Address - Zip Code:84623-5000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 N 100 E APT B7
Practice Address - Street 2:
Practice Address - City:MORONI
Practice Address - State:UT
Practice Address - Zip Code:84646-7659
Practice Address - Country:US
Practice Address - Phone:801-400-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLD WHITE FIRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty