Healthcare Provider Details

I. General information

NPI: 1376235200
Provider Name (Legal Business Name): APOTHEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 200 E STE 2C
ST GEORGE UT
84770-3040
US

IV. Provider business mailing address

301 N 200 E STE 2C
ST GEORGE UT
84770-3040
US

V. Phone/Fax

Practice location:
  • Phone: 435-740-3434
  • Fax:
Mailing address:
  • Phone: 435-740-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. COLBY BACKMAN
Title or Position: CLINICAL DIRECTOR
Credential: CMHC
Phone: 435-740-3434