Provider Demographics
NPI:1518405877
Name:COLEBROOK-CLAUDE, CARNELL A (NCC, LPC,LCPC, LSOE)
Entity Type:Individual
Prefix:DR
First Name:CARNELL
Middle Name:A
Last Name:COLEBROOK-CLAUDE
Suffix:
Gender:F
Credentials:NCC, LPC,LCPC, LSOE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 NORTH OCEAN DRIVE #162
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-686-2020
Mailing Address - Fax:
Practice Address - Street 1:2501 CHATHAM RD STE R
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4188
Practice Address - Country:US
Practice Address - Phone:954-686-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCPC03319101YM0800X
NVCP5260-R101YM0800X
NE1983101YM0800X
FLPMH 1408101YM0800X
KY242477101YM0800X
MTBBH-LCPC-LIC-31419101YM0800X
FLTPMC864101YM0800X
IL272.000205101YM0800X
IL271.000202101YM0800X
NJ37PC00852500101YP2500X
TX76280101YP2500X
IL180.012895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional