Provider Demographics
NPI:1053671222
Name:COLQUITT, LAMONT ANTONIO SR
Entity Type:Individual
Prefix:
First Name:LAMONT
Middle Name:ANTONIO
Last Name:COLQUITT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3587 ASHFORD GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-3532
Mailing Address - Country:US
Mailing Address - Phone:702-749-8500
Mailing Address - Fax:702-749-8509
Practice Address - Street 1:2820 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6514
Practice Address - Country:US
Practice Address - Phone:702-749-8500
Practice Address - Fax:702-749-8509
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst