Individual
TITAN COLBY MARVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM, PSSAD
Contact information
Practice address
109 N.E. MENZANITA AVENUE, GRANTS PASS, OR 97526-1400
(541) 479-8847
(541) 471-2679
Mailing address
109 N.E. MENZANITA AVENUE, GRANTS PASS, OR 97526-1400
(541) 479-8847
(541) 471-2679
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
19-CRM-084
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-CRM-084
MHACBO
OR
Enumeration date
08/13/2019
Last updated
08/13/2019
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