Provider Demographics
NPI:1144914953
Name:CAREY-FRITZ, COLTER TRISTAN
Entity type:Individual
Prefix:
First Name:COLTER
Middle Name:TRISTAN
Last Name:CAREY-FRITZ
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 1:302 3RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56065-2009
Mailing Address - Country:US
Mailing Address - Phone:507-380-4377
Mailing Address - Fax:
Practice Address - Street 1:1811 WEIR DR STE 270
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-6741
Practice Address - Country:US
Practice Address - Phone:651-243-6087
Practice Address - Fax:651-714-9647
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306622101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)