Provider Demographics
NPI:1508238494
Name:MILHOUSE, COLEETTRA
Entity Type:Individual
Prefix:
First Name:COLEETTRA
Middle Name:
Last Name:MILHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 STOCKWELL RD APT 724
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5770
Mailing Address - Country:US
Mailing Address - Phone:318-286-1877
Mailing Address - Fax:
Practice Address - Street 1:2175 STOCKWELL RD APT 724
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5770
Practice Address - Country:US
Practice Address - Phone:318-286-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health