Individual
MR. COLTER BLOXOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3420 E SHEA BLVD STE 188, PHOENIX, AZ 85028-3354
(602) 529-6557
(480) 485-7938
Mailing address
3420 E SHEA BLVD STE 188, PHOENIX, AZ 85028-3354
(602) 529-6557
(480) 485-7938
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
18381
AZ
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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