Provider Demographics
NPI:1104506716
Name:COLIN, MICHAEL ALLAN-JOSEPH (LPC, LMAC, CTP, NCC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLAN-JOSEPH
Last Name:COLIN
Suffix:
Gender:M
Credentials:LPC, LMAC, CTP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-2361
Mailing Address - Country:US
Mailing Address - Phone:231-838-0582
Mailing Address - Fax:
Practice Address - Street 1:8575 W 110TH ST # 208
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1868
Practice Address - Country:US
Practice Address - Phone:913-286-7640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health