Provider Demographics
NPI:1528201308
Name:COLLIER, CARMEN D (CSAC, LPC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:D
Last Name:COLLIER
Suffix:
Gender:F
Credentials:CSAC, 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 365
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:WI
Mailing Address - Zip Code:54155-0365
Mailing Address - Country:US
Mailing Address - Phone:920-490-3874
Mailing Address - Fax:920-490-3845
Practice Address - Street 1:2640 W POINT RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1344
Practice Address - Country:US
Practice Address - Phone:920-490-3874
Practice Address - Fax:920-490-3845
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4436-125101YM0800X, 101YP2500X
WI15370-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100003531Medicaid
WI42174300Medicaid
WI100003531Medicaid