Provider Demographics
NPI:1518141290
Name:KLYM, COLLEEN
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:KLYM
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:EGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:938 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1922
Mailing Address - Country:US
Mailing Address - Phone:530-659-7437
Mailing Address - Fax:
Practice Address - Street 1:800 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-2006
Practice Address - Country:US
Practice Address - Phone:215-443-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 53564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist