Provider Demographics
NPI:1528338662
Name:HAUPT, COLTON RUSSELL (BST/PSR)
Entity type:Individual
Prefix:MR
First Name:COLTON
Middle Name:RUSSELL
Last Name:HAUPT
Suffix:
Gender:M
Credentials:BST/PSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N BUFFALO DR
Mailing Address - Street 2:APT 1027
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1034
Mailing Address - Country:US
Mailing Address - Phone:702-738-2322
Mailing Address - Fax:
Practice Address - Street 1:2201 N BUFFALO DR
Practice Address - Street 2:APT 1027
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1034
Practice Address - Country:US
Practice Address - Phone:702-738-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst