Provider Demographics
NPI:1386964898
Name:PICKLES, COLIN CHRISTOPHER (PSYD)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:CHRISTOPHER
Last Name:PICKLES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 W ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:651-226-1938
Mailing Address - Fax:
Practice Address - Street 1:1211 W ALAMO DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8811
Practice Address - Country:US
Practice Address - Phone:651-226-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist