Provider Demographics
NPI:1962849844
Name:MCCOLLOM, SEAN DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:DOUGLAS
Last Name:MCCOLLOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 AUSTRIAN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2237
Mailing Address - Country:US
Mailing Address - Phone:702-738-6594
Mailing Address - Fax:
Practice Address - Street 1:5550 PAINTED MIRAGE RD STE 320
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4584
Practice Address - Country:US
Practice Address - Phone:702-582-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health