Provider Demographics
NPI:1386197218
Name:COLLEY, KRISTIE (LSW)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:COLLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 STORER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5522
Mailing Address - Country:US
Mailing Address - Phone:216-651-1450
Mailing Address - Fax:216-441-3637
Practice Address - Street 1:6209 STORER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-5522
Practice Address - Country:US
Practice Address - Phone:216-651-1450
Practice Address - Fax:216-651-4351
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0900902101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor