Provider Demographics
NPI:1225186968
Name:MCNALLY, COLLEEN MARIE (MA, LCPC,)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARIE
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:MA, LCPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 ELLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2036
Mailing Address - Country:US
Mailing Address - Phone:708-784-9967
Mailing Address - Fax:
Practice Address - Street 1:8020 W 87TH ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1189
Practice Address - Country:US
Practice Address - Phone:708-741-4500
Practice Address - Fax:708-741-4501
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health