Healthcare Provider Details

I. General information

NPI: 1962319376
Provider Name (Legal Business Name): COLBERT COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 SW C AVE STE 103
LAWTON OK
73501-4060
US

IV. Provider business mailing address

431 SW C AVE STE 103
LAWTON OK
73501-4060
US

V. Phone/Fax

Practice location:
  • Phone: 580-713-8914
  • Fax: 888-416-1731
Mailing address:
  • Phone: 580-713-8914
  • Fax: 888-416-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE COLBERT
Title or Position: COUNSELOR
Credential: MHR,LPC-S
Phone: 580-713-8914