Provider Demographics
NPI:1053861930
Name:RALPHS, COLTON
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:
Last Name:RALPHS
Suffix:
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 1:418 CHENEY ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0912
Mailing Address - Country:US
Mailing Address - Phone:775-525-1616
Mailing Address - Fax:775-201-0147
Practice Address - Street 1:418 CHENEY ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-0912
Practice Address - Country:US
Practice Address - Phone:775-525-1616
Practice Address - Fax:775-201-0147
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
NVCP5030101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker