Provider Demographics
NPI:1891995007
Name:COLBERT, TY (PHD)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:COLBERT
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 1:1335 N SARITA PL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-1327
Mailing Address - Country:US
Mailing Address - Phone:714-532-3214
Mailing Address - Fax:
Practice Address - Street 1:1335 N. SARITA PLACE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-1327
Practice Address - Country:US
Practice Address - Phone:714-532-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY 9242103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical