Provider Demographics
NPI:1457224891
Name:STEINKEN KOLLATH, BRIGITTE
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:STEINKEN KOLLATH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 S LONE PEAK DR
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-4982
Mailing Address - Country:US
Mailing Address - Phone:928-232-4220
Mailing Address - Fax:
Practice Address - Street 1:222 E BIRCH AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5282
Practice Address - Country:US
Practice Address - Phone:928-232-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional