Provider Demographics
NPI:1255848297
Name:COLLEY, ANN L
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:COLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WASHINGTON LN STE 6A2
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-1426
Mailing Address - Country:US
Mailing Address - Phone:267-800-6589
Mailing Address - Fax:773-632-0572
Practice Address - Street 1:25 WASHINGTON LN STE 6A2
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1426
Practice Address - Country:US
Practice Address - Phone:267-800-6589
Practice Address - Fax:773-632-0572
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAMF000977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor