Provider Demographics
NPI:1427368695
Name:COLTER, WESLEY LEROY (RW#3585)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:LEROY
Last Name:COLTER
Suffix:
Gender:M
Credentials:RW#3585
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 POWER INN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-6749
Mailing Address - Country:US
Mailing Address - Phone:916-388-9418
Mailing Address - Fax:916-388-9273
Practice Address - Street 1:5450 POWER INN RD
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-6749
Practice Address - Country:US
Practice Address - Phone:916-388-9418
Practice Address - Fax:916-388-9273
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor