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General NPI Number Information
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NPI Number | 1043220452
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Entity Type | Individual
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Provider Name | COLETTE CUTTER IMPELLIZZERI MA, LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 118 E 8TH ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-6129
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Country | US
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Telephone | 360-457-0431
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Fax | 360-457-0493
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Provider Business Mailing Address
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Address Line | 2504 CAMINO ENTRADA
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City | SANTA FE
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State | NM
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Zip | 87507-4851
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Country | US
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Telephone | 505-216-2727
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Fax | 505-365-1006
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60125447
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1220
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CTB-2023-0477
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License Number State | NM
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