Organization
KOLOB THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA HAM L.C.S.W. (DIRECTOR)
(435) 674-4464
Entity
Organization
Contact information
Practice address
437 S BLUFF ST STE 202, ST GEORGE, UT 84770-3555
(435) 674-4464
Mailing address
437 S BLUFF ST STE 202, ST GEORGE, UT 84770-3555
(435) 674-4464
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1397173501
UT
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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