Provider Demographics
NPI:1063880839
Name:BACKMAN, COLBY GANNON (CMHC)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:GANNON
Last Name:BACKMAN
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 1:301 N 200 E STE 2C
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3040
Mailing Address - Country:US
Mailing Address - Phone:435-414-0464
Mailing Address - Fax:
Practice Address - Street 1:301 N 200 E STE 2C
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3040
Practice Address - Country:US
Practice Address - Phone:435-414-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9835346-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health