Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003238361 |
---|---|
Provider Name | Colbey Bentley |
First Address | Provo, UT 84601-1547 |
Second Address | Provo, UT 84604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2014 |
Last Update Date | 06/01/2014 |