Provider Demographics
NPI:1225433410
Name:COLLEEN MCCLEERY LLC
Entity Type:Organization
Organization Name:COLLEEN MCCLEERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEERY
Authorized Official - Suffix:
Authorized Official - Credentials:IMFT, LICDC
Authorized Official - Phone:440-465-7652
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:STE 608
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3437
Mailing Address - Country:US
Mailing Address - Phone:440-465-7652
Mailing Address - Fax:
Practice Address - Street 1:20525 CENTER RIDGE RD
Practice Address - Street 2:STE 608
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3437
Practice Address - Country:US
Practice Address - Phone:440-465-7652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty