Provider Demographics
NPI:1598829897
Name:JAMES, COLLEEN S (LCSW, LPC, SAC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:S
Last Name:JAMES
Suffix:
Gender:F
Credentials:LCSW, LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 STATE ROAD 136 STE 1
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9252
Mailing Address - Country:US
Mailing Address - Phone:608-477-9858
Mailing Address - Fax:877-560-0578
Practice Address - Street 1:840 STATE ROAD 136 STE 1
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-9252
Practice Address - Country:US
Practice Address - Phone:608-477-9858
Practice Address - Fax:877-560-0578
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2101YP2500X
WI12133101YA0400X
WI36131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39602100Medicaid