Provider Demographics
NPI:1750404646
Name:COLT, KIDD (EDD, LMHC)
Entity type:Individual
Prefix:
First Name:KIDD
Middle Name:
Last Name:COLT
Suffix:
Gender:M
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 BURGOS DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-2714
Mailing Address - Country:US
Mailing Address - Phone:941-921-0897
Mailing Address - Fax:
Practice Address - Street 1:2750 BAHIA VISTA ST
Practice Address - Street 2:SUITE 209
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2600
Practice Address - Country:US
Practice Address - Phone:941-544-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health