Provider Demographics
NPI:1952679359
Name:COLBERG, JAMES EDWARD I (CADC1)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:COLBERG
Suffix:I
Gender:M
Credentials:CADC1
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:COLBERG
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CADC1
Mailing Address - Street 1:3647 HWY 39
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-2612
Mailing Address - Country:US
Mailing Address - Phone:541-884-5244
Mailing Address - Fax:
Practice Address - Street 1:3647 HWY 39
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-2612
Practice Address - Country:US
Practice Address - Phone:541-884-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11-03-04101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)