Provider Demographics
NPI:1396082053
Name:COULTER, MARC JEFFREY
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:JEFFREY
Last Name:COULTER
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 1:5984 S PRINCE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2083
Mailing Address - Country:US
Mailing Address - Phone:303-388-9749
Mailing Address - Fax:303-889-0838
Practice Address - Street 1:5984 S PRINCE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2083
Practice Address - Country:US
Practice Address - Phone:303-388-9749
Practice Address - Fax:303-889-0838
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6044101YA0400X
CO3597101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)