Provider Demographics
NPI:1699830208
Name:MARSHALL, COLLEEN MAE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MAE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S HICKORY STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:951-303-9428
Mailing Address - Fax:760-747-0582
Practice Address - Street 1:240 S HICKORY ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4355
Practice Address - Country:US
Practice Address - Phone:760-747-0205
Practice Address - Fax:760-747-0582
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist