Provider Demographics
NPI:1851650691
Name:COLLAER-MUZZO, CHRISTINE (LCPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:COLLAER-MUZZO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 E CENTER ST
Mailing Address - Street 2:STE A1
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4132
Mailing Address - Country:US
Mailing Address - Phone:208-220-6891
Mailing Address - Fax:208-232-8001
Practice Address - Street 1:120 S 12TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4814
Practice Address - Country:US
Practice Address - Phone:208-709-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID101YP2500X
IDLCPC-4246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional