Provider Demographics
NPI:1780006627
Name:COLBERT, DREW (LPC, LLMFT)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:COLBERT
Suffix:
Gender:M
Credentials:LPC, LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 W CENTRE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-6314
Mailing Address - Country:US
Mailing Address - Phone:269-359-7887
Mailing Address - Fax:
Practice Address - Street 1:1591 W CENTRE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6314
Practice Address - Country:US
Practice Address - Phone:269-359-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013958101YM0800X
MI4101006597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist