Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033572771 |
---|---|
Provider Name | Henry Colbert |
First Address | Rohnert Park, CA 94927-1034 |
Second Address | San Rafael, CA 94903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 30/01/2018 |