Healthcare Provider Details

I. General information

NPI: 1467981126
Provider Name (Legal Business Name): SHAUNA MARIE COLBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MAIN STREET
CRAIG AK
99921
US

IV. Provider business mailing address

PO BOX 1260
CRAIG AK
99921-1260
US

V. Phone/Fax

Practice location:
  • Phone: 907-755-4986
  • Fax: 907-826-2103
Mailing address:
  • Phone: 907-755-4987
  • Fax: 907-826-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: