Provider Demographics
NPI:1659018786
Name:COLIANNI, MICHAEL FRANK
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANK
Last Name:COLIANNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:CALARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:830 TENDERFOOT HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7372
Mailing Address - Country:US
Mailing Address - Phone:888-611-0870
Mailing Address - Fax:888-714-4996
Practice Address - Street 1:1127 S RANCHO DR STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2216
Practice Address - Country:US
Practice Address - Phone:888-611-0870
Practice Address - Fax:888-714-4996
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT2765106S00000X
NVRBT-22-222086106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician