Provider Demographics
NPI:1952531402
Name:COLBERT, LINDA KAYE (EDD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAYE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 FALCON PT
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4302
Mailing Address - Country:US
Mailing Address - Phone:409-771-5258
Mailing Address - Fax:
Practice Address - Street 1:2920 AVENUE M 1/2
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-4350
Practice Address - Country:US
Practice Address - Phone:409-771-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1797193Medicaid