Provider Demographics
NPI:1578098588
Name:COLAHAN-IRETA, PATRICIA A (LPCC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:COLAHAN-IRETA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:327 WILLOW RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5840
Mailing Address - Country:US
Mailing Address - Phone:505-720-3355
Mailing Address - Fax:
Practice Address - Street 1:327 WILLOW RD NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-5840
Practice Address - Country:US
Practice Address - Phone:505-720-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health