1154507168 NPI number — MS. COLLEEN ANN MAHEUX M.A., MFT

Table of content: MS. COLLEEN ANN MAHEUX M.A., MFT (NPI 1154507168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154507168 NPI number — MS. COLLEEN ANN MAHEUX M.A., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHEUX
Provider First Name:
COLLEEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAHEUX
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., MFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1154507168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 S PRATT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89701-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-882-8616
Provider Business Mailing Address Fax Number:
775-882-8616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 S PRATT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89701-4730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-882-8616
Provider Business Practice Location Address Fax Number:
775-882-8616
Provider Enumeration Date:
01/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1070 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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