Basic Information
| Provider Information | |||||||||
| NPI: | 1649796988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKNIGHT | ||||||||
| FirstName: | COLLEEN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 S MONROE ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481612469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342403850 | ||||||||
| FaxNumber: | 7342403863 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 S MONROE ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481612469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342403850 | ||||||||
| FaxNumber: | 7342403863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2017 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401016238 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.