Provider Demographics
NPI:1093796575
Name:COLEY, RAYMOND (LCPC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:COLEY
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 W 110TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3710
Mailing Address - Country:US
Mailing Address - Phone:773-218-0787
Mailing Address - Fax:773-239-6224
Practice Address - Street 1:8941 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-6432
Practice Address - Country:US
Practice Address - Phone:773-218-0787
Practice Address - Fax:773-239-6224
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional