Provider Demographics
NPI:1154507168
Name:MAHEUX, COLLEEN ANN (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ANN
Last Name:MAHEUX
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:ANN
Other - Last Name:MAHEUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:205 S PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4730
Mailing Address - Country:US
Mailing Address - Phone:775-882-8616
Mailing Address - Fax:775-882-8616
Practice Address - Street 1:205 S PRATT AVE
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4730
Practice Address - Country:US
Practice Address - Phone:775-882-8616
Practice Address - Fax:775-882-8616
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist