Provider Demographics
NPI:1235864273
Name:CROSSEY, COLLEEN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:CROSSEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22279 BROCKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4790
Mailing Address - Country:US
Mailing Address - Phone:734-717-8389
Mailing Address - Fax:
Practice Address - Street 1:22279 BROCKSHIRE ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4790
Practice Address - Country:US
Practice Address - Phone:734-717-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI882079889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty