Provider Demographics
NPI:1295915957
Name:COLT, MARSHALL (PHD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:COLT
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 1:1761 HOTEL CIR S
Mailing Address - Street 2:STE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1761 HOTEL CIR S
Practice Address - Street 2:STE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3318
Practice Address - Country:US
Practice Address - Phone:619-886-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-10
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41279106H00000X
FLMT 2102106H00000X
CO269106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist