Provider Demographics
NPI:1114952579
Name:COLWELL, CHRISTINA NA (MA LP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:NA
Last Name:COLWELL
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SNELLING AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6756
Mailing Address - Country:US
Mailing Address - Phone:651-253-1084
Mailing Address - Fax:
Practice Address - Street 1:91 SNELLING AVE N STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6756
Practice Address - Country:US
Practice Address - Phone:651-253-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0046750200Medicare ID - Type Unspecified