=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073324836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COULTER SOMES MFTC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2025
-----------------------------------------------------
Last Update Date | 01/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1169 HILLTOP PKWY UNIT 104H
-----------------------------------------------------
City | STEAMBOAT SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80487-3173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-235-0404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 JACKPINE CT
-----------------------------------------------------
City | STEAMBOAT SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80487-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-235-0404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFTC.0014398
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------