Provider Demographics
NPI:1356619159
Name:COLTEN, JETTA LEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JETTA
Middle Name:LEE
Last Name:COLTEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JETTA
Other - Middle Name:LEE
Other - Last Name:SULLIVAN-WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:3582 PARKMOOR VILLAGE DR APT B
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5224
Mailing Address - Country:US
Mailing Address - Phone:626-806-7553
Mailing Address - Fax:
Practice Address - Street 1:6071 E WOODMEN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2607
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48536106H00000X
COMFT.0001459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist