Provider Demographics
NPI:1598178972
Name:MATLOCK, COLLEEN (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2801
Mailing Address - Country:US
Mailing Address - Phone:918-510-7412
Mailing Address - Fax:
Practice Address - Street 1:123 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2801
Practice Address - Country:US
Practice Address - Phone:918-510-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health