Provider Demographics
NPI:1437661485
Name:INNIS, COLLEEN MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:INNIS
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 1:1601 E 18TH ST STE 224
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1754
Mailing Address - Country:US
Mailing Address - Phone:816-838-9665
Mailing Address - Fax:844-471-7844
Practice Address - Street 1:1601 E 18TH ST STE 224
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1754
Practice Address - Country:US
Practice Address - Phone:816-548-7585
Practice Address - Fax:844-471-7844
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017035037OtherSTATE LICENSE