Provider Demographics
NPI:1275616484
Name:MCCOLLUM PSYCHOLOGY, PC
Entity Type:Organization
Organization Name:MCCOLLUM PSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:ODELL MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:309-762-3931
Mailing Address - Street 1:2101 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3663
Mailing Address - Country:US
Mailing Address - Phone:309-762-3931
Mailing Address - Fax:309-762-4938
Practice Address - Street 1:2101 47TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3663
Practice Address - Country:US
Practice Address - Phone:309-762-3931
Practice Address - Fax:309-762-4938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty