Provider Demographics
NPI:1508187840
Name:WEBB, COLLEEN SUE (MA, QMHP, LPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:SUE
Last Name:WEBB
Suffix:
Gender:F
Credentials:MA, QMHP, LPC
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:ADARHORMAZD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, QMHP, LPC, NCC
Mailing Address - Street 1:685 NW 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6462
Mailing Address - Country:US
Mailing Address - Phone:541-234-7421
Mailing Address - Fax:
Practice Address - Street 1:685 NW 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6462
Practice Address - Country:US
Practice Address - Phone:541-234-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500631638Medicaid