Basic Information
Provider Information | |||||||||
NPI: | 1164561361 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COLVIN | ||||||||
FirstName: | LORI | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMFT, MS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NADEAU | ||||||||
OtherFirstName: | LORI | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LMFT, MS | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5811 MILLS POINT LN | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | TX | ||||||||
PostalCode: | 774696158 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2817996151 | ||||||||
FaxNumber: | 7134697181 | ||||||||
Practice Location | |||||||||
Address1: | 9525 KATY FWY | ||||||||
Address2: | SUITE 213 | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770241407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7134639449 | ||||||||
FaxNumber: | 7134637181 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/05/2007 | ||||||||
LastUpdateDate: | 09/21/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 533 | CO | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 106H00000X | 201358 | TX | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.