Provider Demographics
NPI:1023555422
Name:GRANEY, COLLEEN A (LCPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:GRANEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 W WILLOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1874
Mailing Address - Country:US
Mailing Address - Phone:708-789-0676
Mailing Address - Fax:
Practice Address - Street 1:6390 W WILLOW WOOD DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1874
Practice Address - Country:US
Practice Address - Phone:708-789-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional