MEDICARE: BRITNEY COLQUITT

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1649645680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITNEY COLQUITT

Provider Business Mailing Address
First Line	:	840 W BAYOU PINES DR
Second Line	:	SUITE B
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7495
Country	:	US
Telephone Number	:	337-491-1740
Fax Number	:	337-491-1741

Provider Business Practice Location Address
First Line	:	840 W BAYOU PINES DR
Second Line	:	SUITE B
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7495
Country	:	US
Telephone Number	:	337-491-1740
Fax Number	:	337-491-1741

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

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	12/02/2015

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Directions to “ BRITNEY COLQUITT ” Practice Location

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