Provider Demographics
NPI:1821186677
Name:MCCLEERY, COLLEEN (IMFT, LICDC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MCCLEERY
Suffix:
Gender:F
Credentials:IMFT, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8689 EMERALD OVAL S
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-4211
Mailing Address - Country:US
Mailing Address - Phone:440-465-7652
Mailing Address - Fax:
Practice Address - Street 1:8689 EMERALD OVAL S
Practice Address - Street 2:
Practice Address - City:OLMSTED TWP
Practice Address - State:OH
Practice Address - Zip Code:44138-4211
Practice Address - Country:US
Practice Address - Phone:440-465-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH041001101YA0400X
OHF126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)