Provider Demographics
NPI:1609952928
Name:COLLEY, ANN D (MED, LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:D
Last Name:COLLEY
Suffix:
Gender:F
Credentials:MED, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6224
Mailing Address - Country:US
Mailing Address - Phone:360-457-7766
Mailing Address - Fax:360-417-8145
Practice Address - Street 1:634 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6224
Practice Address - Country:US
Practice Address - Phone:360-457-7766
Practice Address - Fax:360-417-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health