Healthcare Provider Details

I. General information

NPI: 1780986240
Provider Name (Legal Business Name): AIMEE COLBERT CCC, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 NE LOOP 820
FORT WORTH TX
76137-2412
US

IV. Provider business mailing address

PO BOX 14432
HALTOM CITY TX
76117-0432
US

V. Phone/Fax

Practice location:
  • Phone: 817-564-5289
  • Fax:
Mailing address:
  • Phone: 817-564-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: