Provider Demographics
NPI:1043937998
Name:KUREGHIAN, COLLEEN NICOLE
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:NICOLE
Last Name:KUREGHIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19640 FALCON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4024
Mailing Address - Country:US
Mailing Address - Phone:818-398-6953
Mailing Address - Fax:
Practice Address - Street 1:3210 W BURBANK BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2200
Practice Address - Country:US
Practice Address - Phone:818-638-9586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician