Provider Demographics
NPI:1518344860
Name:COLLIGAN, RAYMOND E (MS, LCAC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:COLLIGAN
Suffix:
Gender:M
Credentials:MS, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-1951
Mailing Address - Country:US
Mailing Address - Phone:785-202-0684
Mailing Address - Fax:785-877-3456
Practice Address - Street 1:105 S NORTON AVE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-2163
Practice Address - Country:US
Practice Address - Phone:785-202-0684
Practice Address - Fax:785-877-3456
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)