Provider Demographics
NPI:1033740238
Name:COLOKA, TANYA (LPC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:COLOKA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7654 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2732
Mailing Address - Country:US
Mailing Address - Phone:708-932-3319
Mailing Address - Fax:
Practice Address - Street 1:7654 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2732
Practice Address - Country:US
Practice Address - Phone:708-932-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional