Provider Demographics
NPI:1407036270
Name:KOLTERMAN, WENDA ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:WENDA
Middle Name:ANN
Last Name:KOLTERMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:LYFORD
Mailing Address - State:TX
Mailing Address - Zip Code:78569-0100
Mailing Address - Country:US
Mailing Address - Phone:956-343-1439
Mailing Address - Fax:956-347-3182
Practice Address - Street 1:11360 LA COMA ROAD
Practice Address - Street 2:
Practice Address - City:LYFORD
Practice Address - State:TX
Practice Address - Zip Code:78569-0100
Practice Address - Country:US
Practice Address - Phone:956-343-1439
Practice Address - Fax:956-347-3182
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1793754Medicaid