Provider Demographics
NPI:1487785176
Name:SANTOS, COLLEEN VENTUS (PSYD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:VENTUS
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 CENTER AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9126
Mailing Address - Country:US
Mailing Address - Phone:714-889-1604
Mailing Address - Fax:855-703-3268
Practice Address - Street 1:7755 CENTER AVE STE 700
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9126
Practice Address - Country:US
Practice Address - Phone:714-889-1604
Practice Address - Fax:855-703-3268
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19689103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling