Provider Demographics
NPI:1053577999
Name:JOSEPH, COLIN R (PHD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:R
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:141 S MCCORMICK ST
Mailing Address - Street 2:SUITE 206-M
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4729
Mailing Address - Country:US
Mailing Address - Phone:928-499-8405
Mailing Address - Fax:928-443-1463
Practice Address - Street 1:141 S MCCORMICK ST
Practice Address - Street 2:SUITE 206-M
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4729
Practice Address - Country:US
Practice Address - Phone:928-499-8405
Practice Address - Fax:928-443-1463
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical