Provider Demographics
NPI:1619311776
Name:AZIZ, COLLEEN HARDEN (LCPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:HARDEN
Last Name:AZIZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GENTIAN
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-8544
Mailing Address - Country:US
Mailing Address - Phone:217-369-0819
Mailing Address - Fax:
Practice Address - Street 1:101 GENTIAN
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-8544
Practice Address - Country:US
Practice Address - Phone:217-369-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional