Provider Demographics
NPI:1851969117
Name:COLIN JOSEPH PSYCHOLOGIST PHD PLLC
Entity Type:Organization
Organization Name:COLIN JOSEPH PSYCHOLOGIST PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:SHANNON-JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-499-8405
Mailing Address - Street 1:1666 W PINE CONE WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6123
Mailing Address - Country:US
Mailing Address - Phone:928-499-8405
Mailing Address - Fax:
Practice Address - Street 1:1666 W PINE CONE WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6123
Practice Address - Country:US
Practice Address - Phone:928-499-8405
Practice Address - Fax:928-227-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health