Individual
COURTNEY KOLB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12165 STATE HIGHWAY 14 N STE B7, CEDAR CREST, NM 87008-9538
(505) 913-7771
Mailing address
8 ANASAZI DR, SANDIA PARK, NM 87047-8524
(575) 202-6030
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15171035
—
NM
Enumeration date
10/30/2009
Last updated
05/04/2018
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