MEDICARE: CHRISTOPHER COLVIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1144506296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER COLVIN

Provider Business Mailing Address
First Line	:	PO BOX 41794
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-0794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 N CENTRAL EXPY
Second Line	:	SUITE 560
City	:	DALLAS
State	:	TX
Zip	:	75206-5209
Country	:	US
Telephone Number	:	214-727-4046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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Directions to “ CHRISTOPHER COLVIN ” Practice Location

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