Provider Demographics
NPI:1407584493
Name:COLVARD, CARRIE J (LPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:COLVARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:LANING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:6440 S LEWIS AVE STE 2200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1060
Practice Address - Country:US
Practice Address - Phone:918-712-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional