Provider Demographics
NPI:1134458938
Name:COLBURN, CHRISTINE (LPC, NCC, CCTP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:COLBURN
Suffix:
Gender:F
Credentials:LPC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W CHANDLER BLVD. #220
Mailing Address - Street 2:C/O CHRISTINE COLBURN
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-500-8074
Mailing Address - Fax:480-809-6548
Practice Address - Street 1:1600 W CHANDLER BLVD. STE 220
Practice Address - Street 2:C/O CHRISTINE COLBURN
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-500-8074
Practice Address - Fax:480-809-6548
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ250785OtherNATIONAL CERTIFIED COUNSELOR
AZ17895OtherLICENSED PROFESSIONAL COUNSELOR (LPC)
AZCCTPOtherCERTIFIED CLINICAL TRAUMA PROFESSIONAL