Provider Demographics
NPI:1851171524
Name:PRIEST, COLIN (LMHC, LMT, CRC)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:PRIEST
Suffix:
Gender:M
Credentials:LMHC, LMT, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-9420
Mailing Address - Country:US
Mailing Address - Phone:515-257-6415
Mailing Address - Fax:
Practice Address - Street 1:6165 NW 86TH ST # 222
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2270
Practice Address - Country:US
Practice Address - Phone:515-257-6415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA118878225700000X
IA110753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist