Provider Demographics
NPI:1679587570
Name:SEVILLE, COLLEEN SUSAN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:SUSAN
Last Name:SEVILLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W GRAND AVE
Mailing Address - Street 2:#209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-4171
Mailing Address - Country:US
Mailing Address - Phone:312-593-7585
Mailing Address - Fax:
Practice Address - Street 1:300 W GRAND AVE
Practice Address - Street 2:209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-4171
Practice Address - Country:US
Practice Address - Phone:312-593-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional