Basic Information
| Provider Information | |||||||||
| NPI: | 1881279883 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | COLLEEN | ||||||||
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| Credential: | APRN: PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8441 STATE HWY 47 | ||||||||
| Address2: | STE 3115 | ||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778076306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9794369703 | ||||||||
| FaxNumber: | 9794360072 | ||||||||
| Practice Location | |||||||||
| Address1: | 3211 INNSBRUCK CIR | ||||||||
| Address2: | |||||||||
| City: | COLLEGE STATION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778456306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9794461509 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2021 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 1031762 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1Y0470 | 01 | TX | PTAN | OTHER |