Provider Demographics
NPI:1871216846
Name:NAYLOR, COLLEEN ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1011A CACTUS CT
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-5013
Mailing Address - Country:US
Mailing Address - Phone:760-821-0551
Mailing Address - Fax:
Practice Address - Street 1:1011A CACTUS CT
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-5013
Practice Address - Country:US
Practice Address - Phone:720-724-6243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1101251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical