Provider Demographics
NPI:1073545331
Name:COLON, MYRNA (LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740421
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-0421
Mailing Address - Country:US
Mailing Address - Phone:386-742-1219
Mailing Address - Fax:386-742-0190
Practice Address - Street 1:75 FOX RIDGE CT
Practice Address - Street 2:SUITE C
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2701
Practice Address - Country:US
Practice Address - Phone:386-742-1219
Practice Address - Fax:386-742-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health