Provider Demographics
NPI:1922031863
Name:COLCLOUGH, ROBERT (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:COLCLOUGH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEMORIAL HOSPITAL DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1199
Mailing Address - Country:US
Mailing Address - Phone:251-344-2762
Mailing Address - Fax:251-344-5492
Practice Address - Street 1:100 MEMORIAL HOSPITAL DR STE 2A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1199
Practice Address - Country:US
Practice Address - Phone:251-344-2762
Practice Address - Fax:251-344-5492
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC 111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515 92047OtherBLUE CROSS
AL515 92986OtherBLUE CROSS