Provider Demographics
NPI:1871748657
Name:COLWELL, STEVEN RALPH (LPT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:RALPH
Last Name:COLWELL
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 W HAMMOND AVE
Mailing Address - Street 2:APT B.
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2200
Mailing Address - Country:US
Mailing Address - Phone:559-761-7944
Mailing Address - Fax:
Practice Address - Street 1:637 W HAMMOND AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2200
Practice Address - Country:US
Practice Address - Phone:559-761-7944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22969167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician