Provider Demographics
NPI:1083188015
Name:HARGETT, COLLEEN BETH
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:BETH
Last Name:HARGETT
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 1:14215 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-8231
Mailing Address - Country:US
Mailing Address - Phone:909-292-8847
Mailing Address - Fax:
Practice Address - Street 1:14215 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92344-8231
Practice Address - Country:US
Practice Address - Phone:909-292-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling