Provider Demographics
NPI:1013400183
Name:TRETTON, COLLEEN M (LPC, SEP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:TRETTON
Suffix:
Gender:F
Credentials:LPC, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 W GRANITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-4732
Mailing Address - Country:US
Mailing Address - Phone:928-308-3129
Mailing Address - Fax:
Practice Address - Street 1:2850 W GRANITE OAKS DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-4732
Practice Address - Country:US
Practice Address - Phone:928-308-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional