Provider Demographics
NPI:1164561361
Name:COLVIN, LORI ANN (LMFT, MS)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:COLVIN
Suffix:
Gender:F
Credentials:LMFT, MS
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:NADEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, MS
Mailing Address - Street 1:5811 MILLS POINT LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6158
Mailing Address - Country:US
Mailing Address - Phone:281-799-6151
Mailing Address - Fax:713-469-7181
Practice Address - Street 1:9525 KATY FWY
Practice Address - Street 2:SUITE 213
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1407
Practice Address - Country:US
Practice Address - Phone:713-463-9449
Practice Address - Fax:713-463-7181
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO533106H00000X
TX201358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841333288Medicare UPIN