Provider Demographics
NPI:1457486029
Name:COLKIN, JOE T JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:T
Last Name:COLKIN
Suffix:JR
Gender:M
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 203
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TX
Mailing Address - Zip Code:75764-0203
Mailing Address - Country:US
Mailing Address - Phone:903-521-2957
Mailing Address - Fax:903-683-6818
Practice Address - Street 1:770 PINEY GROVE RD
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-3317
Practice Address - Country:US
Practice Address - Phone:903-521-2957
Practice Address - Fax:903-683-6818
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional