Healthcare Provider Details

I. General information

NPI: 1154139343
Provider Name (Legal Business Name): REBECCA M COLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BECKY COLEY

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 E 950 S
OREM UT
84058-7054
US

IV. Provider business mailing address

276 E 950 S
OREM UT
84058-7054
US

V. Phone/Fax

Practice location:
  • Phone: 801-845-4406
  • Fax:
Mailing address:
  • Phone: 801-845-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142747003904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: