Provider Demographics
NPI:1174642268
Name:COLT, AMBER M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:M
Last Name:COLT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11495 PENNSYLVANIA ST STE 126
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6804
Mailing Address - Country:US
Mailing Address - Phone:317-796-5365
Mailing Address - Fax:317-663-2927
Practice Address - Street 1:11495 PENNSYLVANIA ST STE 126
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6804
Practice Address - Country:US
Practice Address - Phone:317-796-5365
Practice Address - Fax:317-663-2927
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003883A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical