Healthcare Provider Details

I. General information

NPI: 1538081682
Provider Name (Legal Business Name): COLTEN MANNING RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 2ND ST STE A
CLINTON MO
64735-2172
US

IV. Provider business mailing address

210 S 2ND ST STE A
CLINTON MO
64735-2172
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-2394
  • Fax: 660-383-1650
Mailing address:
  • Phone: 660-885-2394
  • Fax: 660-383-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2829619
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: