Healthcare Provider Details

I. General information

NPI: 1699142984
Provider Name (Legal Business Name): HEATHER M COLQUHOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12183 LOCKSLEY LN STE 102
AUBURN CA
95602-2050
US

IV. Provider business mailing address

PO BOX 6028
AUBURN CA
95604-6028
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1961
  • Fax: 916-797-8979
Mailing address:
  • Phone: 530-878-5166
  • Fax: 916-797-8979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: