Provider Demographics
NPI:1316429301
Name:COLTON, CHRISTIAN J (LPC, QMHP)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:J
Last Name:COLTON
Suffix:
Gender:M
Credentials:LPC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 DAYNA LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7340
Mailing Address - Country:US
Mailing Address - Phone:541-579-8834
Mailing Address - Fax:
Practice Address - Street 1:175 W B ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4575
Practice Address - Country:US
Practice Address - Phone:541-579-8834
Practice Address - Fax:541-636-2847
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC6297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500754351Medicaid