Basic Information
| Provider Information | |||||||||
| NPI: | 1699142984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLQUHOUN | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6028 | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956046028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308785166 | ||||||||
| FaxNumber: | 9167978979 | ||||||||
| Practice Location | |||||||||
| Address1: | 12183 LOCKSLEY LN STE 102 | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956022050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308851961 | ||||||||
| FaxNumber: | 9167978979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2015 | ||||||||
| LastUpdateDate: | 08/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.