Healthcare Provider Details

I. General information

NPI: 1306119946
Provider Name (Legal Business Name): KAY COLBERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 DOUGLAS AVE STE 375
DALLAS TX
75225-5923
US

IV. Provider business mailing address

5445 LA SIERRA DR STE 103
DALLAS TX
75231-4139
US

V. Phone/Fax

Practice location:
  • Phone: 214-905-5090
  • Fax: 214-905-1998
Mailing address:
  • Phone: 214-864-5981
  • Fax: 214-739-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number52411
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: