Healthcare Provider Details

I. General information

NPI: 1851969117
Provider Name (Legal Business Name): COLIN JOSEPH PSYCHOLOGIST PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 07/19/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 W PINE CONE WAY
PRESCOTT AZ
86303-6123
US

IV. Provider business mailing address

1666 W PINE CONE WAY
PRESCOTT AZ
86303-6123
US

V. Phone/Fax

Practice location:
  • Phone: 928-499-8405
  • Fax: 928-227-2574
Mailing address:
  • Phone: 928-499-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA LOU SHANNON-JOSEPH
Title or Position: OFFICE MANAGER
Credential:
Phone: 928-499-8405