Healthcare Provider Details

I. General information

NPI: 1306442181
Provider Name (Legal Business Name): COLIN WILFORD CMHC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N STATE STREET
OREM UT
84057
US

IV. Provider business mailing address

4021 W CYPRESS
CEDAR HILLS UT
84062
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-0695
  • Fax: 801-434-8333
Mailing address:
  • Phone: 801-432-0695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11816985-6004
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: