Provider Demographics
NPI:1386013753
Name:GROTE, COLLEEN MICHELE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MICHELE
Last Name:GROTE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2802
Mailing Address - Country:US
Mailing Address - Phone:319-233-3579
Mailing Address - Fax:319-233-6569
Practice Address - Street 1:904 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2802
Practice Address - Country:US
Practice Address - Phone:319-233-3579
Practice Address - Fax:319-233-6569
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health