Provider Demographics
NPI:1720587389
Name:TURQUOISE TRAIL COUNSELING LLC
Entity Type:Organization
Organization Name:TURQUOISE TRAIL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-202-6030
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-0086
Mailing Address - Country:US
Mailing Address - Phone:575-202-6030
Mailing Address - Fax:
Practice Address - Street 1:12165 STATE HIGHWAY 14 N STE B7
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9538
Practice Address - Country:US
Practice Address - Phone:575-202-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health