Provider Demographics
NPI:1619097300
Name:JEWELL, COLLEEN MARY (MA LLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARY
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 GRAND RIVER RD STE I
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9558
Mailing Address - Country:US
Mailing Address - Phone:810-844-7300
Mailing Address - Fax:
Practice Address - Street 1:10299 GRAND RIVER RD STE I
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9558
Practice Address - Country:US
Practice Address - Phone:810-844-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010643103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling