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Individual
SHASTA NICOLE COLTHARP
Active
Individual
SHASTA NICOLE COLTHARP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
106S00000X
Behavior Technician
—
—
225400000X
Rehabilitation Practitioner
—
—
225XM0800X
Mental Health Occupational Therapist
Primary
24351
CA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
06/21/2018
Last updated
06/17/2026
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