Provider Demographics
NPI:1851431092
Name:LAREAU, COLLEEN M (LPC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:LAREAU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3324
Mailing Address - Country:US
Mailing Address - Phone:217-685-3739
Mailing Address - Fax:
Practice Address - Street 1:604 N 2ND ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3324
Practice Address - Country:US
Practice Address - Phone:217-685-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013487103TB0200X, 103TC1900X
IL178008774101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-2831313OtherAGENCY TAX NUMBER
MI260D16159OtherBCBS GROUP NUMBER