Provider Demographics
NPI:1922529619
Name:COLTON, MARY PAMELA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:PAMELA
Last Name:COLTON
Suffix:
Gender:F
Credentials:LPC
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 664
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-0664
Mailing Address - Country:US
Mailing Address - Phone:505-550-7129
Mailing Address - Fax:
Practice Address - Street 1:2218 SOUTHERN BLVD SE STE 14
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3750
Practice Address - Country:US
Practice Address - Phone:505-994-0161
Practice Address - Fax:505-994-0162
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health