Provider Demographics
NPI:1427019124
Name:ORBIN, RAY LEON (CMHC)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:LEON
Last Name:ORBIN
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 1:1866 E PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4603
Mailing Address - Country:US
Mailing Address - Phone:801-709-9706
Mailing Address - Fax:
Practice Address - Street 1:1866 E. PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-4603
Practice Address - Country:US
Practice Address - Phone:801-709-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT349521-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007789102Medicaid
UT87-0479971OtherTIN FOR RLO & ASSOCIATES
UT87-0676482OtherTIN FOR FRONT LINE SER