Healthcare Provider Details

I. General information

NPI: 1093995300
Provider Name (Legal Business Name): CHRISTINE ANN PULITO-COLBERT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 SPYRES WAY
MODESTO CA
95356-9800
US

IV. Provider business mailing address

800 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMW20309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: