Healthcare Provider Details

I. General information

NPI: 1568745065
Provider Name (Legal Business Name): MRS. SKYLAR COLLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2086 COMMERCE AVE
CONCORD CA
94520-4902
US

IV. Provider business mailing address

876 VALENCIA APT. B
SAN FRANCISCO CA
94110
US

V. Phone/Fax

Practice location:
  • Phone: 925-234-8363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number03848453
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number78512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: