Healthcare Provider Details

I. General information

NPI: 1699694414
Provider Name (Legal Business Name): TODD ALLEN COLICHIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12520 WILLOW SPRINGS RD STE 100
HASLET TX
76052-3584
US

IV. Provider business mailing address

8412 REVENUE WAY
NORTH RICHLAND HILLS TX
76182-7416
US

V. Phone/Fax

Practice location:
  • Phone: 214-797-4871
  • Fax:
Mailing address:
  • Phone: 214-797-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number103062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: