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NPI Code Detail

MEDICARE: MR. COLTON RUSSELL HAUPT BST/PSR

MEDICARE:  MR. COLTON RUSSELL HAUPT  BST/PSR
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
1102L00000XPsychoanalyst
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1528338662
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COLTON RUSSELL HAUPT BST/PSR
Provider Business Mailing Address
First Line : 2201 N BUFFALO DR
Second Line : APT 1027
City : LAS VEGAS
State : NV
Zip : 89128-1034
Country : US
Telephone Number : 702-738-2322
Fax Number :
Provider Business Practice Location Address
First Line : 2201 N BUFFALO DR
Second Line : APT 1027
City : LAS VEGAS
State : NV
Zip : 89128-1034
Country : US
Telephone Number : 702-738-2322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2012
Last Update Date : 01/05/2012

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Directions to “ MR. COLTON RUSSELL HAUPT BST/PSR” Practice Location

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