Basic Information
| Provider Information | |||||||||
| NPI: | 1851645592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLTS | ||||||||
| FirstName: | RUSSELL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 31237 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992233020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099986265 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10103 N DIVISION ST | ||||||||
| Address2: | SUITE 109 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992181380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094671156 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2012 | ||||||||
| LastUpdateDate: | 11/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY60198057 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.