Provider Demographics
NPI:1851645592
Name:KOLTS, RUSSELL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:L
Last Name:KOLTS
Suffix:
Gender:M
Credentials:PHD
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 31237
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3020
Mailing Address - Country:US
Mailing Address - Phone:509-998-6265
Mailing Address - Fax:
Practice Address - Street 1:10103 N DIVISION ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1380
Practice Address - Country:US
Practice Address - Phone:509-467-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60198057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical