Provider Demographics
NPI:1396036661
Name:COLLEY, CAROL (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:COLLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:MO
Mailing Address - Zip Code:65606-0344
Mailing Address - Country:US
Mailing Address - Phone:417-270-1515
Mailing Address - Fax:417-778-1515
Practice Address - Street 1:RURAL ROUTE 72
Practice Address - Street 2:BOX 219001
Practice Address - City:ALTON
Practice Address - State:MO
Practice Address - Zip Code:65606
Practice Address - Country:US
Practice Address - Phone:417-270-1515
Practice Address - Fax:417-778-1515
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009511101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor