Provider Demographics
NPI:1811186919
Name:COLWELL, CHERYL (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:COLWELL
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 1:302 S KITCHELL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-1500
Mailing Address - Country:US
Mailing Address - Phone:618-392-8255
Mailing Address - Fax:618-392-8255
Practice Address - Street 1:302 S KITCHELL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-1500
Practice Address - Country:US
Practice Address - Phone:618-392-8255
Practice Address - Fax:618-392-8255
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005996101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180-005996OtherLCPC
IL376006178008Medicaid
IL207184Medicare Oscar/Certification
IL180-005996OtherLCPC