Provider Demographics
NPI:1851156210
Name:SCHUBERT, COLLEEN (P-LPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:SCHUBERT
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FALLS XING
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-5603
Mailing Address - Country:US
Mailing Address - Phone:678-977-3099
Mailing Address - Fax:
Practice Address - Street 1:1085 STARK RD STE F
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3682
Practice Address - Country:US
Practice Address - Phone:662-601-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health